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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Top 10 Claim Denial Reasons and Resolutions/Workarounds for October 2025 Professional Claims. See Web Announcement 3767.

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. Provider_Enrollment_Information_Booklet.pdf
... Provider. Gainwell Technologies is the current Quality Improvement Organization (QIO) -like vendor for the Nevada Medicaid and Nevada Check Up programs. State Policy Nevada Medicaid ...
Terms matched: 1  -  Score: 14  -  05 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
2. Error_Code_to_EOB_to_ANSI.pdf
... provider on the approved PA. Work with occurrence has been reached. the PBM vendor to correct provider information. 3032 TOOTH CODE BILLED DOES NOT MATCH 505 Tooth ...
Terms matched: 1  -  Score: 11  -  04 Nov 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
3. web_announcement_3753_20251024.pdf
... Urban Washoe and Clark County residents, please continue to schedule with the Non-Emergency Transportation vendor, MTM, at (844) 879-7341. 16. Will dental coverage ...
Terms matched: 1  -  Score: 12  -  24 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3753_20251024.pdf
4. web_announcement_3751_20251021.pdf
... Waiver for Persons with Physical Disabilities or a Financial Management Services (FMS) Medicaid vendor. FMS is only available for providers rendering services for PD recipients. If ...
Terms matched: 1  -  Score: 20  -  21 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3751_20251021.pdf
5. NV_Flex_User_Guide_Group.pdf
... provider or a fiscal agent. Fiscal agent means a contractor that processes or pays vendor claims on behalf of the Medicaid agency. Managing employee means a general manager ...
Terms matched: 1  -  Score: 34  -  21 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Flex_User_Guide_Group.pdf
6. NV_Flex_User_Guide_Individual.pdf
... provider or a fiscal agent. Fiscal agent means a contractor that processes or pays vendor claims on behalf of the Medicaid agency. Updated: 10/21/ ...
Terms matched: 1  -  Score: 12  -  21 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Flex_User_Guide_Individual.pdf
7. Benefit_Enrollment_and_Maintenance_(834).pdf
... providers and their Trading Partners. It is critical that your IT staff or software vendor review this document in its entirety and follow the stated requirements to exchange HIPAA-compliant ...
Terms matched: 1  -  Score: 106  -  20 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Benefit_Enrollment_and_Maintenance_(834).pdf
8. NV_Billing_General_20250801.pdf
... overpayments. The phone number and email address for First Health Services’ TPL vendor, Health Management Services, has been updated in chapters 2 and 5. ...
Terms matched: 1  -  Score: 161  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20250801.pdf
9. NV_Billing_General.pdf
... overpayments. The phone number and email address for First Health Services’ TPL vendor, Health Management Services, has been updated in chapters 2 and 5. ...
Terms matched: 1  -  Score: 157  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
10. NV_EVS_User_Manual_Ch8.pdf
... (Selected from the list of valid codes in the ASC X12 Guide; your vendor/Clearinghouse should have the list of valid codes.) â – ª ...
Terms matched: 1  -  Score: 20  -  17 Oct 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch8.pdf
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