Nevada Medicaid and Nevada Check Up News (Second 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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IMPORTANT: Nevada Medicaid is conducting a swift revalidation effort on high risk providers. If selected, you will receive a revalidation notice with instructions through the standard communication process. See Web Announcement 3935 for more information.

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for July 2026 Professional Claims. See Web Announcement 3983.

Top Prior Authorization Denial Reasons for the Second Quarter of 2026. See Web Announcement 3978.

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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111. companionguide837P.pdf
... Nevada Medicaid and Nevada Check Up Professional Health Care Claims and Managed Care Organization (MCO) Encounters Nevada Medicaid Management Information System (NV MMIS) State of Nevada ...
Terms matched: 1  -  Score: 223  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/companionguide837P.pdf
112. companionguide837I.pdf
... Nevada Medicaid and Nevada Check Up Institutional Health Care Claims and Managed Care Organization (MCO) Encounter Claims Nevada Medicaid Management Information System (NV MMIS) State of ...
Terms matched: 1  -  Score: 223  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/companionguide837I.pdf
113. 837_Encounter-Professional_837P_MCO_Mod_n061818.pdf
... the submitter for correction. (When resubmitting a rejected encounter claim, the same MCO ICN/TCN must be used on the corrected encounter claim.) The ...
Terms matched: 1  -  Score: 222  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/837_Encounter-Professional_837P_MCO_Mod_n061818.pdf
114. companionguide837D.pdf
... Nevada Medicaid and Nevada Check Up Dental Health Care Claims and Managed Care Organization (MCO) Encounter Claims Nevada Medicaid Management Information System (NV MMIS) State of ...
Terms matched: 1  -  Score: 213  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/companionguide837D.pdf
115. NV_Medicaid_News_2017-0714.pdf
... , 2017. Upgrades to the Nevada Medicaid Provider Web Portal that benefit all (MCO) Changes Effective providers will include: July 1, 2017 ï ‚ increased ...
Terms matched: 1  -  Score: 211  -  04 Aug 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Medicaid_News_2017-0714.pdf
116. 837_Encounter-Institutional_837I_MCO_Mod_n061818.pdf
... the submitter for correction. (When resubmitting a rejected encounter claim, the same MCO ICN/TCN must be used on the corrected encounter claim.) The ...
Terms matched: 1  -  Score: 210  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/837_Encounter-Institutional_837I_MCO_Mod_n061818.pdf
117. NDC_Frequently_Asked_Questions.pdf
... sections that follow provide details on Fee-For-Service (FFS) and Managed Care Organization (MCO) Claims. Fee-for-service claims Q: Why does Nevada Medicaid require a National ...
Terms matched: 1  -  Score: 189  -  10 Oct 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NDC_Frequently_Asked_Questions.pdf
118. web_announcement_2655_20211215.pdf
... Announcement 2655 Attention All Providers: Recipients May Request to Change Managed Care Organization (MCO) Plans In December, Medicaid recipients who are members of Managed Care Organizations ...
Terms matched: 1  -  Score: 186  -  20 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2655_20211215.pdf
119. NV_BillingGuidelines_PT22_20080519.pdf
... eligibility For recipients age 21 and older, Nevada programs are not transitioned to an MCO. Medicaid covers only necessary dentures, emergency extractions and palliative care. It ...
Terms matched: 1  -  Score: 183  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20080519.pdf
120. FA-16B.pdf
... ASSESSING THE RECIPIENT’S NEEDS. ASSESSMENT NEEDS MEDICATION/IV DELIVERY NEEDS Choose one: This is based on the severity of illness and the stability of ...
Terms matched: 1  -  Score: 174  -  20 Jun 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-16B.pdf
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