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. Provider_Enrollment_Information_Booklet.pdf
... Institution for Mental beds and more than 50% of care is primarily engaged in ... Institution for Mental beds and more than 50% of care is primarily engaged in ...
Terms matched: 2  -  Score: 21  -  27 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
2. NV_Billing_General.pdf
... only) • Total units/days billed ... 01/2026 36 o 50 â€" Claim ... Non-Check Related o 51 â€" Adjustments †...
Terms matched: 3  -  Score: 54  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
3. NV_Billing_General_20260101.pdf
... only) • Total units/days billed ... 15/2025 36 o 50 â€" Claim ... Non-Check Related o 51 â€" Adjustments †...
Terms matched: 3  -  Score: 54  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260101.pdf
4. NV_EVS_User_Manual_Ch1.pdf
... 48 1.8.1. Inactive Delegate Accounts ... 50 1.8.2. Switching providers as a delegate ... 48 1.8.1. Inactive Delegate Accounts ... 50 1.8.2. Switching providers as a delegate ...
Terms matched: 2  -  Score: 63  -  18 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch1.pdf
5. Error_Code_to_EOB_to_ANSI.pdf
... Missing/incomplete/invalid total charges. submission/ ... /10/2026 Page 50 of 186 Claim Error ... EOB/ANSI Code Crosswalk ERROR_CODE ERROR_CODE_DESCRIPTION EOB_CODE EOB_CODE_DESCRIPTION REASON_CODE ...
Terms matched: 3  -  Score: 511  -  18 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
6. Known_Issues.pdf
... ¢ 270-(Header Total Billed Amount Missing) ... issue has been resolved. 50 Claims, Provider The ... Type 44 Billing Guidelines informs • Provider: ...
Terms matched: 3  -  Score: 101  -  17 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
7. NV_EVS_User_Manual_Ch3.pdf
... Step 2 • Total Charged Amount †... • Up to 50 service details to be ... to a dental claim • Procedure codes are ...
Terms matched: 3  -  Score: 373  -  17 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch3.pdf
8. NV_BillingGuidelines_PT14.pdf
... These limits are a combined total of all sessions used ... family. service limits. 50 minutes; bill one ... per day 90847 Family Psychotherapy (with See Outpatient QMHP ...
Terms matched: 3  -  Score: 68  -  14 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14.pdf
9. NV_BillingGuidelines_PT14_online_011226.pdf
... grid. 90846 Family Psychotherapy (without 50 minutes; bill one QMHP, The ... grid. 90846 Family Psychotherapy (without 50 minutes; bill one QMHP, The ...
Terms matched: 2  -  Score: 45  -  14 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT14_online_011226.pdf
10. 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  -  29 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA.pdf
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