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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261. 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
262. Atypical (Second-Generation) Antipsychotics.pdf
... first 1 to 2 weeks of therapy; therefore, this must be considered when choosing an agent for 10 the acute treatment of schizophrenia. Lurasidone is indicated for ...
Terms matched: 1  -  Score: 59  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Atypical%20(Second-Generation)%20Antipsychotics.pdf
263. Atypical (Second-Generation) Antipsychotics_07232012.pdf
... first 1 to 2 weeks of therapy; therefore, this must be considered when choosing an agent for 10 the acute treatment of schizophrenia. Lurasidone is indicated for ...
Terms matched: 1  -  Score: 59  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Atypical%20(Second-Generation)%20Antipsychotics_07232012.pdf
264. Binder_DUR_2018_1018.pdf
... unfortunately similar to what the other ones are. After seeing their recommendations from the MCO as saying that they would just like to keep this criteria. Chapter 1200 ...
Terms matched: 1  -  Score: 59  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Binder_DUR_2018_1018.pdf
265. web_announcement_2658_20211217.pdf
... 2658 Attention All Providers: Recipient/Enrollee Webpage Created with Managed Care Organization (MCO) Expansion Information Effective immediately, a new webpage has been created on the ...
Terms matched: 1  -  Score: 58  -  17 Dec 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2658_20211217.pdf
266. NV_BillingGuidelines_PT75_20111111.pdf
... DHCFP that have swing bed licensure and certification. Requesting Authorization To request authorization: MCO vs. FFS ï ‚ Complete and fax form FA-3 or FA-8 as When ...
Terms matched: 1  -  Score: 58  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT75_20111111.pdf
267. 2_Medicaid_Program_Highlights_DHCFP_2014.pdf
... • Advanced Practice Registered Nurses • Physician Forums with FFS and MCO • Prior Authorization Alignment between FFS and MCO • Health ...
Terms matched: 1  -  Score: 57  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/2_Medicaid_Program_Highlights_DHCFP_2014.pdf
268. Anthem_DUR_Binder_Jan_2021.pdf
... Presentation Presented to NV DUR Board on January 28, 2021 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 57  -  06 Jan 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Anthem_DUR_Binder_Jan_2021.pdf
269. E-Binder_SSSB_September_2021.pdf
... within 6 months of discontinuation (Level A) . Physicians and people with MS choosing to switch from natalizumab to ï ngolimod should initiate treatment within 8 to 12 ...
Terms matched: 1  -  Score: 56  -  16 Sep 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/E-Binder_SSSB_September_2021.pdf
270. web_announcement_988_20150929.pdf
... for no prior authorization due to a change in eligibility from Managed Care Organization (MCO) to Fee-for-Service (FFS) after a newborn’s date of ...
Terms matched: 1  -  Score: 56  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_988_20150929.pdf
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