Nevada Medicaid and Nevada Check Up News (First Quarter 2026 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 April 2026 Professional Claims. See Web Announcement 3915.

Top Prior Authorization Denial Reasons for the First Quarter of 2026. See Web Announcement 3900.

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 https://NevadaMedicaid.nv.gov/ and the Billing Guide for your provider type at www.medicaid.nv.gov.

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1. PT_34_Therapy_Tip_Sheet.pdf
... Authorization Nevada Medicaid Criteria YouTube: PA Search Overview Provider Day Calculator Web Portal Fee WA 1728 Schedule (FA-7 Search Information) Nevada WA 3609 Medicaid (Medical Record ...
Terms matched: 1  -  Score: 35  -  12 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PT_34_Therapy_Tip_Sheet.pdf
2. Known_Issues.pdf
... 14/2019 10/05/2020 02/11/2021 Type 32 Air or Ground) have denied incorrectly with error • Once resolved, ...
Terms matched: 1  -  Score: 49  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Known_Issues.pdf
3. 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  -  06 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Error_Code_to_EOB_to_ANSI.pdf
4. NV_BillingGuidelines_PT11.pdf
... a proprietary, nationally recognized standard utilized by Nevada Medicaid’s QIO -like vendor to perform utilization management, determine medical necessity, and appropriate level of care ...
Terms matched: 1  -  Score: 12  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11.pdf
5. NV_BillingGuidelines_PT11_online_082725.pdf
... is a proprietary, nationally recognized standard utilized by Nevada Medicaid’s QIO-like vendor to perform utilization management, determine medical necessity, and appropriate level of care ...
Terms matched: 1  -  Score: 12  -  01 May 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11_online_082725.pdf
6. NV_BillingGuidelines_PT60.pdf
... 92551 Screening test, pure tone, air only. • Encounter = ... develop strength and endurance, range of motion and flexibility. • Limited ...
Terms matched: 2  -  Score: 39  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
7. NV_BillingGuidelines_PT60_2025-1216.pdf
... 92551 Screening test, pure tone, air only. • Encounter = ... develop strength and endurance, range of motion and flexibility. • Limited ...
Terms matched: 2  -  Score: 39  -  29 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2025-1216.pdf
8. Provider_Enrollment_Information_Booklet.pdf
... Improvement Organization (QIO) -like vendor for the Nevada Medicaid and Nevada Check ... Agency (EVV Required) Ambulance, Air or Ground Specialty type code: 32 ...
Terms matched: 2  -  Score: 39  -  21 Apr 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Provider_Enrollment_Information_Booklet.pdf
9. NV_Billing_Justice_Initiative.pdf
... ) Audiology (Hearing) Code Descriptions Limitations 92551 Screening test, pure tone, air only 92552 Pure tone audiometry; air only 92553 Pure tone audiometry; air ...
Terms matched: 1  -  Score: 35  -  18 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_Justice_Initiative.pdf
10. NV_BillingGuidelines_PT87.pdf
... MSM Chapter 4400. If you need further clarification, please contact the Medicaid QIO-like vendor. Crisis Services are only billable for actively enrolled Medicaid recipients and MCO members ...
Terms matched: 1  -  Score: 21  -  17 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT87.pdf
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