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]

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NOTIFICATION: Some Provider Flex services will be temporarily unavailable due to scheduled maintenance from 7 p.m. Pacific Time on Friday, March 6, 2026, to 11 a.m. Pacific Time on Saturday, March 7, 2026.

During this time:
  • New enrollment applications cannot be started.
  • Revalidation and Update applications will remain available; and
  • Previously started applications can still be accessed and resumed.

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.

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for January 2026 Professional Claims. See Web Announcement 3840.

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.

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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.

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1. NV_BillingGuidelines_PT25-41.pdf
... Provider Types 25 and 41 Billing Guide Optometrist, Optician and Optical Business Policy ... €¢ For eyeglasses, recipients age 21 and older require PA if the 12-month ...
Terms matched: 2  -  Score: 266  -  03 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT25-41.pdf
2. NV_BillingGuidelines_PT25-41_20241218.pdf
... Provider Types 25 and 41 Billing Guide Optometrist, Optician and Optical Business Policy ... €¢ For eyeglasses, recipients age 21 and older require PA if the 12-month ...
Terms matched: 2  -  Score: 191  -  03 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT25-41_20241218.pdf
3. Provider_Enrollment_Information_Booklet.pdf
... General Information.... 1 Nevada Medicaid Provider Types and Specialties.... 1 Table 1: ... Providers Urgent/Emergency Services .... 21 Fingerprint-based Criminal Background Check (FCBC) ...
Terms matched: 2  -  Score: 674  -  27 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
4. web_announcement_3816_20260112.pdf
... for more information. January 12, 2026 Nevada Medicaid Web Announcement 3816 Attention Provider Types 24 (Advanced Practice Registered Nurses), 74 (Nurse Midwife) and ...
Terms matched: 1  -  Score: 89  -  23 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3816_20260112.pdf
5. NV_Billing_General_20260101.pdf
... of all providers, regardless of provider type (PT), at least every ... 228-1308 ext. 59840. 04/21/2014 Multiple updates include: Updated ...
Terms matched: 2  -  Score: 210  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260101.pdf
6. NV_Billing_General.pdf
... of all providers, regardless of provider type (PT), at least every ... 228-1308 ext. 59840. 04/21/2014 Multiple updates include: Updated ...
Terms matched: 2  -  Score: 210  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
7. NV_EVS_User_Manual_Ch1.pdf
... they have at least one active provider type, or the provider’s ... . Granting access to a delegate.... 21 1.7.1. Adding a new delegate ... ...
Terms matched: 2  -  Score: 47  -  18 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch1.pdf
8. NV_Flex_User_Guide_Getting_Started.pdf
... all required enrollment information specific to provider type/specialty. FAQs FAQs - Frequently ... Updated 02/18/2026 Page 21 of 45 pv09/02/2025 ...
Terms matched: 2  -  Score: 23  -  18 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Flex_User_Guide_Getting_Started.pdf
9. Error_Code_to_EOB_to_ANSI.pdf
... REF), if present. 273 TYPE OF BILL MISSING 4100 The type of ... REASON_CODE_DESCRIPTION REMARK_CODE REMARK_CODE_DESCRIPTION 332 ENCOUNTER POS = 21 HOSP ADMIT DATE 2400 Encounter Place of ...
Terms matched: 2  -  Score: 370  -  18 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
10. NV_BillingGuidelines_PT85_Spec320.pdf
... Provider Type 85 Specialty 320 Billing Guide Applied Behavior Analysis: Health Home for Beneficiaries with Fetal Alcohol Spectrum Disorder Overview Nevada’s Health Home for beneficiaries ...
Terms matched: 1  -  Score: 115  -  18 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT85_Spec320.pdf
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