Nevada Medicaid and Nevada Check Up News (Fourth 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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NOTIFICATION: Some Provider Flex services will be temporarily unavailable due to scheduled maintenance from 7 p.m. Pacific Time on Friday, March 6, 2026, to 11 a.m. Pacific Time on Saturday, March 7, 2026.

During this time:
  • New enrollment applications cannot be started.
  • Revalidation and Update applications will remain available; and
  • Previously started applications can still be accessed and resumed.

URGENT NOTIFICATION: Update regarding the Electronic Visit Verification (EVV) claims processing error. Nevada Medicaid did not receive some claims from Sandata (Optum) in time for the February 06, 2026 financial cycle. The issue was resolved this week. EVV providers can contact Sandata Technologies at (833) 545-0394 or support@sandata.com for assistance.

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for January 2026 Professional Claims. See Web Announcement 3840.

Top Prior Authorization Denial Reasons for the Fourth Quarter of 2025. See Web Announcement 3830.

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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11. NV_Billing_General_20150701.pdf
... ï ‚ Prior Authorization requirements ï ‚ New TPL contractor contact information ï ‚ New MCO contact information 08/08/2008 Chapter 8 updated to reflect the mandatory ...
Terms matched: 1  -  Score: 253  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20150701.pdf
12. Selective_Serotonin_(5-HT1)_Agonists_2013-0812.pdf
... (P value not reported) . When permitted to years of age with attacks choose between eletriptan and sumatriptan SC for subsequent treatment, 78% of vs migraine ...
Terms matched: 1  -  Score: 26  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Selective_Serotonin_(5-HT1)_Agonists_2013-0812.pdf
13. Platelet_Inhibitors_2013-0812.pdf
... stroke: no therapy is suggested over antithrombotic therapy. For Therapy and patients who choose antithrombotic therapy, aspirin is suggested over Prevention of oral anticoagulation or combination therapy ...
Terms matched: 1  -  Score: 53  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Platelet_Inhibitors_2013-0812.pdf
14. NV_Billing_General_online_2005-12-29_to_2007-08-09.pdf
... recipient or his/her guardian may choose to send an appeal to the DHCFP ... Dates of eligibility • Which MCO (or “HMOâ€) ...
Terms matched: 2  -  Score: 129  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_online_2005-12-29_to_2007-08-09.pdf
15. NV_Billing_General_online_2007-08-09_to_2008-08-08.pdf
... Managed Care .... 18 Fee For Service.... 18 Managed Care .... 18 MCO Contact Information .... 18 Health Plan of Nevada (HPN) .... ...
Terms matched: 1  -  Score: 315  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_online_2007-08-09_to_2008-08-08.pdf
16. Serotonin and Norepinephrine Reuptake Inhibitors_2014_0811.pdf
... of discontinuation symptoms than other SSRIs. o Take into account toxicity in overdose when choosing an antidepressant for people at significant risk for suicide. Be aware that compared ...
Terms matched: 1  -  Score: 21  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Serotonin%20and%20Norepinephrine%20Reuptake%20Inhibitors_2014_0811.pdf
17. PCS_Presentation_2012_ver1_0_050712.pdf
... program is a rehabilitation program for recipients by request. TRUE or FALSE 2. Choose the service not covered under the PCS program. a. Bathing and Dressing ...
Terms matched: 1  -  Score: 12  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/PCS_Presentation_2012_ver1_0_050712.pdf
18. Selective_Serotonin_(5-HT1)_Receptor_Agonists_2013-0510.pdf
... (P value not reported) . When permitted to years of age with attacks choose between eletriptan and sumatriptan SC for subsequent treatment, 78% of vs migraine ...
Terms matched: 1  -  Score: 26  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Selective_Serotonin_(5-HT1)_Receptor_Agonists_2013-0510.pdf
19. Oral_Atypical_Antipsychotics_2013-0812.pdf
... during the first two weeks of therapy; therefore, this must be considered when choosing 10 an agent for the acute treatment of schizophrenia. Lurasidone is indicated for ...
Terms matched: 1  -  Score: 70  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Oral_Atypical_Antipsychotics_2013-0812.pdf
20. NV_Billing_General_20160202.pdf
... ï ‚ Prior Authorization requirements ï ‚ New TPL contractor contact information ï ‚ New MCO contact information 08/08/2008 Chapter 8 updated to reflect the mandatory ...
Terms matched: 1  -  Score: 248  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20160202.pdf
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