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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251. NV_BillingGuidelines_PT46_20170724.pdf
... versus Fee For Service When a recipient is enrolled in a Managed Care Organization (MCO), request prior authorization from and submit claims to the MCO. When ...
Terms matched: 1  -  Score: 36  -  23 Jul 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT46_20170724.pdf
252. web_announcement_1417_20170728.pdf
... period, recipients will be able to choose from one of the three MCOs: ... Aetna Better Health Managed Care Organization (MCO) has decided to terminate its contract ...
Terms matched: 2  -  Score: 70  -  28 Jul 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_1417_20170728.pdf
253. 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
254. UB-04 Payerpath Training 2016-1213.pdf
... p.m. PT | Email: nvmmis.edisupport@dxc.com 19 Claims List Filter Select Institutional Choose from Untransmitted (claims not yet sent) or Transmitted (claims that have ...
Terms matched: 1  -  Score: 21  -  07 Aug 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/UB-04%20Payerpath%20Training%202016-1213.pdf
255. web_announcement_1423_20170808.pdf
... of Health Care Financing and Policy (DHCFP) as a Managed Care Organization (MCO) for Nevada Medicaid and Nevada Check Up recipients will end. Medicaid and ...
Terms matched: 1  -  Score: 59  -  08 Aug 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_1423_20170808.pdf
256. NV_MMIS_PASRR_Training_2015-1202_Final.pdf
... â€Has depressive d/o stable on meds’ . Note: Choosing major depression will trigger PASRR to come to manual review status and may trigger ...
Terms matched: 1  -  Score: 12  -  11 Aug 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_MMIS_PASRR_Training_2015-1202_Final.pdf
257. web_announcement_1432_20170824.pdf
... , 2017, are denying in error with edit code 0453 (Enrolled in an MCO) . As of July 1, 2017, all dental services claims are ...
Terms matched: 1  -  Score: 20  -  24 Aug 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_1432_20170824.pdf
258. web_announcement_1389_20170605.pdf
... ) form. Remind your patients to choose an MCO during Medicaid Managed Care Open ... by the current Managed Care Organizations (MCO) . As of July 1, ...
Terms matched: 2  -  Score: 69  -  29 Aug 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_1389_20170605.pdf
259. NV_Billing_General_20170724.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: 284  -  01 Sep 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20170724.pdf
260. NV_Billing_General_20170314.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: 280  -  01 Sep 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20170314.pdf
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