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 June 2026 Professional Claims. See Web Announcement 3964.

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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141. companionguide834_hipaa-01-12.pdf
... Number REF01 Reference 36 38 = Master Policy Number Identification Qualifier REF02 Reference 36 10-digit MCO Atypical Provider Identification Identifier 1000A N1 Sponsor Name N102 Plan Sponsor Name 39 Division ...
Terms matched: 1  -  Score: 24  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/companionguide834_hipaa-01-12.pdf
142. companionguide820_hipaa.pdf
... EDI 835 transaction) . 7.3. Frequency An 820 transaction is created for each MCO and payment for each recipient that is enrolled in the MCO for the following ...
Terms matched: 1  -  Score: 24  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/companionguide820_hipaa.pdf
143. companionguide820_hipaa-01-12.pdf
... specified.) This companion guide provides specific requirements for providing Managed Care Organization (MCO) capitation payment information using the 820 transaction. 1.2. Intended use The ...
Terms matched: 1  -  Score: 38  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/companionguide820_hipaa-01-12.pdf
144. companionguide820.pdf
... specified.) This Companion Guide provides specific requirements for providing Managed Care Organization (MCO) capitation payment information using the EDI 820 transaction. HP Enterprise Services creates ...
Terms matched: 1  -  Score: 81  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/companionguide820.pdf
145. companionguide270-271_hipaa.pdf
... Protocol (SFTP) client software and it is up to the trading partner to choose which client software they will use. HPES does not provide or recommend any ...
Terms matched: 1  -  Score: 13  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/companionguide270-271_hipaa.pdf
146. Colony_Stimulating_Factors_GG-CSF_2015-0812.pdf
... the guidelines regarding the specific CSFs within the class. The NCCN states that when choosing an agent for the treatment of prophylaxis of febrile neutropenia, filgrastim and pegfilgrastim ...
Terms matched: 1  -  Score: 43  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Colony_Stimulating_Factors_GG-CSF_2015-0812.pdf
147. CMS-1500_Instructions_posted_2011-12-05_through_2013-05-14.pdf
... ER visit payment 1048 Primary carrier has paid full charges 1072 Newborn/Mother in MCO, bill MCO 1049 Recipient not eligible 1073 Credit balance process 1050 Services not ...
Terms matched: 1  -  Score: 25  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/CMS-1500_Instructions_posted_2011-12-05_through_2013-05-14.pdf
148. Clinical_Material_2016-0411.pdf
... guidelines regarding the specific CSFs within the class. o The NCCN states that when choosing an agent for the treatment of prophylaxis of febrile neutropenia, filgrastim and pegfilgrastim ...
Terms matched: 1  -  Score: 43  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Clinical_Material_2016-0411.pdf
149. CMS Payerpath Training 2016-1205.pdf
... | Email: nvmmis.edisupport@dxc.com 19 Claims List Filter Select Form: Type Professional Choose from Untransmitted (claims not yet sent) or Transmitted (claims that have ...
Terms matched: 1  -  Score: 21  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/CMS%20Payerpath%20Training%202016-1205.pdf
150. Claims_and_PA_Conference_Presentation.pdf
... €œSubmitâ€Nevada Medicaid Provider Training 58 Delegate Assignment, continued †' Choose the Functions you want the delegate to be able to perform †' ...
Terms matched: 1  -  Score: 25  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Claims_and_PA_Conference_Presentation.pdf
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