Nevada Medicaid and Nevada Check Up News (Fourth Quarter 2025 Provider Newsletter) [Read]

Attention Behavioral Health Providers: Monthly Behavioral Health Training Assistance (BHTA) Webinar Scheduled [See Web Announcement 2009]

Attention All Providers: Requirements on When to Use the National Provider Identifier (NPI) of an Ordering, Prescribing or Referring (OPR) Provider on Claims [Announcement 850]

If you are a Medicaid provider whose revalidation application has not been processed by your termination due date, you will be ineligible to provide services to any Nevada Medicaid or Nevada Check Up recipients, including both Fee-for-Service and Managed Care Organization (MCO) enrolled recipients. See Web Announcement 1265

Enrollment Termination Frequently Asked Questions (FAQs) [Review]

Notifications

URGENT NOTIFICATION: Update regarding the Electronic Visit Verification (EVV) claims processing error. Nevada Medicaid did not receive some claims from Sandata (Optum) in time for the February 06, 2026 financial cycle. The issue was resolved this week. EVV providers can contact Sandata Technologies at (833) 545-0394 or support@sandata.com for assistance.

EDI Trading Partners: If you have not already scheduled a migration date for your SFTP connection to the new URL, please contact NV MMIS EDI Support immediately. SFTP services at sftp.medicaid.nv.gov will be discontinued starting January 21, 2026.
Email: nvmmis.edisupport
@gainwelltechnologies.com

Phone: 1-877-638-3472

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for December 2025 Professional Claims. See Web Announcement 3789.

Top Prior Authorization Denial Reasons for the Fourth Quarter of 2025. See Web Announcement 3830.

Attention Providers Using the Authorization Criteria Function: Results that return prior authorization (PA) requirements are accurate. For results that return “There are no records found based on the search criteria,” there may be a PA requirement if limits have been exceeded. To verify PA requirements, please refer to the Medicaid Services Manual (MSM) Chapter for your service type at dhcfp.nv.gov and the Billing Guide for your provider type at www.medicaid.nv.gov.

Scheduled Site Maintenance

During the scheduled site maintenance window the Provider Web Portal will be unavailable. The table below shows the regularly scheduled maintenance window. All times will be in the Pacific time zone.

Monday - Friday
12:00AM - 12:30AM

Monday
8:00PM - 12:00AM

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... provider website For more information about PT 93, see the following web announcements (WA): • WA 3383 • WA 3452 †...
Terms matched: 1  -  Score: 124  -  20 Feb 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3560_20250220.pdf
... weeks), there was no difference in ACR 20 and ACR 50 between the anti- TNF and control groups, but patients originally randomized to anti-TNF were more ...
Terms matched: 1  -  Score: 11  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Immunomodulators_2018-0910.pdf
... weeks), there was no difference in ACR 20 and ACR 50 between the anti- TNF and control groups, but patients originally randomized to anti-TNF were more ...
Terms matched: 1  -  Score: 11  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Immunomodulators_2018-09.pdf
... Emery P, Greenwald MW, et al. Rituximab for rheumatoid arthritis refractory to anti â€"tumor necrosis factor therapy results of a multicenter, randomized, ...
Terms matched: 1  -  Score: 29  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Immunomodulators_2017-0615.pdf
... , safety and tolerability of tofacitinib in patients with an inadequate response to disease modifying anti- rheumatic drugs: a meta-analysis of randomized double-blind controlled studies. BMC Musculoskelet ...
Terms matched: 1  -  Score: 92  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Immunomodulators_2015-0930.pdf
... , safety and tolerability of tofacitinib in patients with an inadequate response to disease modifying anti- rheumatic drugs: a meta-analysis of randomized double-blind controlled studies. BMC Musculoskelet ...
Terms matched: 1  -  Score: 12  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Immunomodulators_2016-12.pdf
... , safety and tolerability of tofacitinib in patients with an inadequate response to disease modifying anti- rheumatic drugs: a meta-analysis of randomized double-blind controlled studies. BMC Musculoskelet ...
Terms matched: 1  -  Score: 92  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Immunomodulators_2015-0812.pdf
... arthritis who have had an inadequate syringe : response to one or more disease modifying anti- 162 mg/0.9 mL rheumatic drugs; patients two years of age ...
Terms matched: 1  -  Score: 110  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Immunomodulators_2014-0918.pdf
... arthritis who have had an inadequate syringe : response to one or more disease modifying anti- 162 mg/0.9 mL rheumatic drugs; patients two years of age ...
Terms matched: 1  -  Score: 71  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Immunomodulators_2013-1218.pdf
... arthritis who have had an inadequate vials: response to one or more disease modifying anti- 80 mg/4 mL rheumatic drugs. 200 mg/10 mL ...
Terms matched: 1  -  Score: 81  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Immunomodulators_2013-0812.pdf
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