Nevada Medicaid and Nevada Check Up News (Third 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: The Provider Pre-Admission Screening Resident Review (PASRR) service will be unavailable from 8 p.m. to midnight Pacific Time on Monday, January 12, 2026, for scheduled maintenance.

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

Provider Flex is now LIVE for all provider types!
For information and training opportunities on this exciting new enrollment tool, please visit our Provider Flex page

Known System Issues-Click HERE

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

Top Prior Authorization Denial Reasons for the Third Quarter of 2025. See Web Announcement 3758.

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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1. Error_Code_to_EOB_to_ANSI.pdf
... . 16 Claim/service lacks information or has M54 Missing/incomplete/invalid total charges. submission/billing error(s ) . Usage: Do not ...
Terms matched: 1  -  Score: 242  -  08 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
2. Known_Issues.pdf
... the following edits on the Web Portal: • 270-(Header Total Billed Amount Missing) • 508-(HDR Billed AMT Not ...
Terms matched: 1  -  Score: 28  -  07 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
3. NV_BillingGuidelines_PT22-attachmentA.pdf
... D7945 BONE CUTTING BODY MANDIBLE 01 01 01 Once in a lifetime D7946 RECONSTRUCTION MAXILLA TOTAL 01 01 01 Once in a lifetime D7947 RECONSTRUCT MAXILLA SEGMENT 01 01 01 ...
Terms matched: 1  -  Score: 12  -  02 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA.pdf
4. NV_BillingGuidelines_PT34.pdf
... combination of occurrence- and time-based codes may be used but may not exceed a total of four units. • Other Instructions: Other important information regarding ...
Terms matched: 1  -  Score: 104  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT34.pdf
5. NV_BillingGuidelines_PT34_2023-1121.pdf
... combination of occurrence- and time-based codes may be used but may not exceed a total of four units. • Other Instructions: Other important information regarding ...
Terms matched: 1  -  Score: 94  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT34_2023-1121.pdf
6. NV_Billing_General_20251215.pdf
... are not greater than the units authorized (outpatient claims only) • Total units/days billed on a claim are not greater than total units/ ...
Terms matched: 1  -  Score: 21  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20251215.pdf
7. NV_Billing_General.pdf
... are not greater than the units authorized (outpatient claims only) • Total units/days billed on a claim are not greater than total units/ ...
Terms matched: 1  -  Score: 21  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
8. NV_Billing_General_20251017.pdf
... are not greater than the units authorized (outpatient claims only) • Total units/days billed on a claim are not greater than total units/ ...
Terms matched: 1  -  Score: 21  -  31 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20251017.pdf
9. NV_BillingGuidelines_PT85_20250304.pdf
... the individual for a limited number of specific behavioral targets. This limitation applies to total combined number of units of codes 97153, 97155 and 0373T. Comprehensive Delivery ...
Terms matched: 1  -  Score: 38  -  22 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT85_20250304.pdf
10. NV_BillingGuidelines_PT85.pdf
... the individual for a limited number of specific behavioral targets. This limitation applies to total combined number of units of codes 97153, 97155 and 0373T. Comprehensive Delivery ...
Terms matched: 1  -  Score: 38  -  22 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT85.pdf
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