Nevada Medicaid and Nevada Check Up News (First 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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Provider Flex is coming soon!
For information and training opportunities on this exciting new enrollment tool, please visit our Provider Flex page

Attention Provider Types 14 and 82:
Please note that the Online Provider Enrollment (OPE) tool will be unavailable to begin any NEW enrollment applications for these provider types from June 9, 2025 – June 16, 2025. Please refer to Web Announcement 3595 for details.

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Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for March 2025 Professional Claims. See Web Announcement 3616.

Top Prior Authorization Denial Reasons for the First Quarter of 2025. See Web Announcement 3630.

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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161. web_announcement_Volume 18 Issue 3 v2_20211025.pdf
... providers and • Home Health Care providers The four Managed Care Organization (MCO) vendors will not be notified of their assigned membership in time to com ...
Terms matched: 1  -  Score: 103  -  25 Oct 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_Volume%2018%20Issue%203%20v2_20211025.pdf
162. web_announcement_Volume%2018%20Issue%203_20211011.pdf
... providers and • Home Health Care providers The four Managed Care Organization (MCO) vendors will not be notified of their assigned membership in time to com ...
Terms matched: 1  -  Score: 103  -  22 Oct 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_Volume%252018%2520Issue%25203_20211011.pdf
163. web_announcement_Volume%2018%20Issue%203_20211011_v2.pdf
... providers and • Home Health Care providers The four Managed Care Organization (MCO) vendors will not be notified of their assigned membership in time to com ...
Terms matched: 1  -  Score: 103  -  22 Oct 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_Volume%252018%2520Issue%25203_20211011_v2.pdf
164. web_announcement_Volume_18_Issue_03_20211011_v2.pdf
... providers and • Home Health Care providers The four Managed Care Organization (MCO) vendors will not be notified of their assigned membership in time to com ...
Terms matched: 1  -  Score: 103  -  22 Oct 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_Volume_18_Issue_03_20211011_v2.pdf
165. Anthem_DUR_Binder_April_2021.pdf
... Presentation Presented to NV DUR Board on April 22, 2021 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 103  -  02 Apr 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Anthem_DUR_Binder_April_2021.pdf
166. web_announcement_655_20131021.pdf
... when a managed care recipient is allowed to switch from one Managed Care Organization (MCO) to the other. Previously, a recipient (with no other household ...
Terms matched: 1  -  Score: 102  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_655_20131021.pdf
167. NV_BillingGuidelines_PT22_20090801.pdf
... and recipient is transitioned to a Managed Care routine maintenance to promote dental Organization (MCO) at the beginning of health. their second full month of eligibility. ...
Terms matched: 1  -  Score: 100  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20090801.pdf
168. companionguide834.pdf
... , Cancellations and Audits. It counts all recipients with at least one day of MCO enrollment in the current or subsequent month. Ethnicity Codes The 834 transaction includes ...
Terms matched: 1  -  Score: 100  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/companionguide834.pdf
169. NV_BillingGuidelines_PT22_20110621.pdf
... the recipient is transitioned to a certain restorative services and routine Managed Care Organization (MCO) at the maintenance to promote dental health. beginning of their second full ...
Terms matched: 1  -  Score: 100  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20110621.pdf
170. NV_BillingGuidelines_PT22_20080827.pdf
... and recipient is transitioned to a Managed Care routine maintenance to promote dental Organization (MCO) at the beginning of health. their second full month of eligibility. ...
Terms matched: 1  -  Score: 100  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22_20080827.pdf
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