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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361. web_announcement_2463_20210331.pdf
... - Service (FFS) recipients and those participating in a Managed Care Organization (MCO) . Providers/prescribers must submit all PA requests to OptumRx for review ...
Terms matched: 1  -  Score: 38  -  31 Mar 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2463_20210331.pdf
362. NV_BillingGuidelines_PT96_20250520.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: 38  -  04 Aug 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT96_20250520.pdf
363. NV_BillingGuidelines_PT96.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: 38  -  04 Aug 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT96.pdf
364. NV_Medicaid_News_2015-0710.pdf
... by the Division of Health Care Financing and Policy (DHCFP) Benefits, and MCO or 10 business days prior to the date of the requested training. If ...
Terms matched: 1  -  Score: 38  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Medicaid_News_2015-0710.pdf
365. NV_BillingGuidelines_PT32_online_20091228.pdf
... not require prior authorization. For Managed support, non-emergency transport claim Care Organization (MCO) enrollees, check A0429 Ambulance service, basic life 1 unit per with ...
Terms matched: 1  -  Score: 38  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT32_online_20091228.pdf
366. NV_BillingGuidelines_PT32_online_20091123.pdf
... not require prior authorization. For Managed support, non-emergency transport claim Care Organization (MCO) enrollees, check A0429 Ambulance service, basic life 1 unit per with ...
Terms matched: 1  -  Score: 38  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT32_online_20091123.pdf
367. NV_BillingGuidelines_PT32_online_20070824.pdf
... prior authorization. For Managed Care A0430 Ambulance service, 1 unit per Organization (MCO) enrollees, check with the conventional air services, claim MCO for special ...
Terms matched: 1  -  Score: 38  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT32_online_20070824.pdf
368. NV_BillingGuidelines_PT32_20100630.pdf
... . For Managed Care A0428 Ambulance service, basic life 1 unit per Organization (MCO) enrollees, check with the support, non-emergency transport claim MCO for special ...
Terms matched: 1  -  Score: 38  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT32_20100630.pdf
369. NV_BillingGuidelines_PT43_20101202.pdf
... in a Managed Care and/or respiratory therapists’ drawing of Organization (MCO), it is the laboratory’s arterial blood. responsibility to ...
Terms matched: 1  -  Score: 38  -  15 Mar 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43_20101202.pdf
370. NV_BillingGuidelines_PT43_20110127.pdf
... in a Managed Care and/or respiratory therapists’ drawing of Organization (MCO), it is the laboratory’s arterial blood. responsibility to ...
Terms matched: 1  -  Score: 38  -  15 Mar 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43_20110127.pdf
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