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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Top 10 Claim Denial Reasons and Resolutions/Workarounds for February 2026 Professional Claims. See Web Announcement 3863.

Top Prior Authorization Denial Reasons for the Fourth Quarter of 2025. See Web Announcement 3830.

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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401. NV_BillingGuidelines_PT12_online_20120710.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  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT12_online_20120710.pdf
402. NV_BillingGuidelines_PT12_online_20150227.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  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT12_online_20150227.pdf
403. NV_BillingGuidelines_PT12_online_20150403.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  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT12_online_20150403.pdf
404. 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
405. NV_BillingGuidelines_PT12_online_20190131.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  -  15 Nov 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT12_online_20190131.pdf
406. New_Provider_Orientation_030619.pdf
... . Select a Site Key image 8. Enter a unique Passphrase 8 9. Choose 3 Challenge Questions from the drop- 9 down list and create a unique ...
Terms matched: 1  -  Score: 37  -  02 Feb 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/New_Provider_Orientation_030619.pdf
407. web_announcement_3186_20231011.pdf
... EVV system. Essentials to Know: State EVV Sandata Users: If a provider chooses to use the state EVV system through Sandata, they can continue to have ...
Terms matched: 1  -  Score: 37  -  11 Oct 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3186_20231011.pdf
408. NV_BillingGuidelines_PT10.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: 37  -  29 Jan 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT10.pdf
409. NV_BillingGuidelines_PT56_20111111.pdf
... a recipient is enrolled in a Managed least) 30-day increments and Care Organization (MCO), request prior ï ‚ Provide a weekly summary of the authorization from ...
Terms matched: 1  -  Score: 37  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT56_20111111.pdf
410. web_announcement_3023_20230302.pdf
... claim to the by HMO Plan appropriate Nevada Medicaid HMO/Managed Care Organization (MCO) for processing. Provider may find out which MCO the recipient belongs to ...
Terms matched: 1  -  Score: 36  -  02 Mar 2023  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3023_20230302.pdf
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