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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NOTIFICATION: The following Nevada Medicaid Provider Web Portal services will be unavailable from 8 p.m. Pacific Time on Monday, May 11, 2026, through 4 a.m. Pacific Time on Tuesday, May 12, 2026, for scheduled maintenance:
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    Top 10 Claim Denial Reasons and Resolutions/Workarounds for March 2026 Professional Claims. See Web Announcement 3894.

    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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11. NV_BillingGuidelines_PT87_Spec250_090324.pdf
... first complete year of operation as a provider of ICSS, providers of ICSS who choose to have a cost-based bundled daily rate will be required to submit a cost ...
Terms matched: 1  -  Score: 23  -  17 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT87_Spec250_090324.pdf
12. NV_BillingGuidelines_PT87.pdf
... Medicaid QIO-like vendor. Crisis Services are only billable for actively enrolled Medicaid recipients and MCO members. Billing Prior Authorization Brief Description Unit / Service Description Code Requirement Specialty ...
Terms matched: 1  -  Score: 21  -  17 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT87.pdf
13. NV_BillingGuidelines_PT17_Spec181.pdf
... methodology for approved services provided by FQHC qualified health professionals. Managed Care Organizations (MCO) are required to follow Nevada Medicaid’s State Plan and Medicaid ...
Terms matched: 1  -  Score: 52  -  06 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Spec181.pdf
14. NV_BillingGuidelines_PT17_Specialty_181_20260102.pdf
... methodology for approved services provided by FQHC qualified health professionals. Managed Care Organizations (MCO) are required to follow Nevada Medicaid’s State Plan and Medicaid ...
Terms matched: 1  -  Score: 47  -  06 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Specialty_181_20260102.pdf
15. ABA_FAQ.pdf
... ) Frequently Asked Questions (FAQ) If a member is receiving services under an MCO and then changes to FFS, what is the correct way to request authorization ...
Terms matched: 1  -  Score: 134  -  03 Mar 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/ABA_FAQ.pdf
16. NV_Billing_General.pdf
... 2026 30 Available transactions Trading Partners can choose to enroll for the following HIPAA Standard ... contractor contact information • New MCO contact information 08/08/2008 ...
Terms matched: 2  -  Score: 200  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General.pdf
17. NV_Billing_General_20260101.pdf
... 2025 30 Available transactions Trading Partners can choose to enroll for the following HIPAA Standard ... contractor contact information • New MCO contact information 08/08/2008 ...
Terms matched: 2  -  Score: 195  -  20 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20260101.pdf
18. NV_EVS_User_Manual_Ch1.pdf
... Providers, please note: If you choose to have an office administrator register on ... Registering as a Managed Care Organization (MCO) ... 43 1.8. Logging in ...
Terms matched: 2  -  Score: 83  -  18 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_EVS_User_Manual_Ch1.pdf
19. NV_Flex_User_Guide_Getting_Started.pdf
... .... 16 Forgot Password â€" Delegate .... 18 Forgot Password - MCO .... 22 Forgot Password - Trading Partner .... 24 1.5. Expired ...
Terms matched: 1  -  Score: 32  -  18 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Flex_User_Guide_Getting_Started.pdf
20. NV_BillingGuidelines_PT85_Spec320.pdf
... duplication of services, the HHP will contact ManagedCare@nvha.nv.gov to verify that the MCO is not already providing these services to the recipient. Health Home for beneficiaries ...
Terms matched: 1  -  Score: 68  -  18 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT85_Spec320.pdf
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