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.

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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.

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311. E-Binder_PT_March_2019.pdf
... Opioid Treatment Program. In addition, DATA reduced the regulatory burden on physicians who choose to practice opioid addiction therapy by permitting qualified physicians to apply for and receive ...
Terms matched: 1  -  Score: 12  -  18 Feb 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/E-Binder_PT_March_2019.pdf
312. NV_BillingGuidelines_PT17_Specialty 181_20181109.pdf
... to pay FQHCs providing services under a contract with a Medicaid Managed Care Organization (MCO; also known as a Managed Care Entity [MCE]) supplemental payments ...
Terms matched: 1  -  Score: 23  -  18 Feb 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT17_Specialty%20181_20181109.pdf
313. NV_BillingGuidelines_PT12_online_20151001.pdf
... Service (FFS) When a recipient is enrolled in a Managed Care Organization (MCO), request PA from and submit claims to the MCO. For recipients ...
Terms matched: 1  -  Score: 37  -  19 Feb 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT12_online_20151001.pdf
314. NV_BillingGuidelines_PT11_online_100716.pdf
... Service (FFS) 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: 31  -  19 Feb 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT11_online_100716.pdf
315. NV_BillingGuidelines_PT29_online_20181228.pdf
... by Managed Care Organizations (MCOs) . If a recipient is enrolled in an MCO, you must bill the MCO directly. If the recipient is enrolled in ...
Terms matched: 1  -  Score: 35  -  27 Feb 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT29_online_20181228.pdf
316. NV_BillingGuidelines_PT75_online_062618.pdf
... Fee-For-Service (FFS) 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: 31  -  27 Feb 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT75_online_062618.pdf
317. Opioid_Use_Disorder_Agents_2019-0312.pdf
... Opioid Treatment Program. In addition, DATA reduced the regulatory burden on physicians who choose to practice opioid addiction therapy by permitting qualified physicians to apply for and receive ...
Terms matched: 1  -  Score: 16  -  12 Mar 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Opioid_Use_Disorder_Agents_2019-0312.pdf
318. NV_Billing_General_20190201.pdf
... Prior Authorization requirements • New TPL contractor contact information • New MCO contact information 08/08/2008 Chapter 8 updated to reflect the mandatory ...
Terms matched: 1  -  Score: 276  -  18 Mar 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Billing_General_20190201.pdf
319. Binder_DUR_2019-0425.pdf
... reduced the regulatory burden on physicians who choose to practice opioid addiction therapy by permitting ... ? There are some differences with the MCO. Jennifer Wheeler: They changed to ...
Terms matched: 2  -  Score: 113  -  20 Mar 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Binder_DUR_2019-0425.pdf
320. DUR_Annual_Survey_FFY2018.pdf
... was discussed with current utilization and savings presented. Program comparisons between FFS and each MCO were discussed. The main differences found being the MCO’s allow ...
Terms matched: 1  -  Score: 12  -  20 Mar 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/DUR_Annual_Survey_FFY2018.pdf
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