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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441. Narcolepsy_Agents_2021-04.pdf
... to work out how they would have affected you. Use the following scale to choose the most appropriate number for each situation: ï ‚ 0 = would never ...
Terms matched: 1  -  Score: 10  -  05 Mar 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Narcolepsy_Agents_2021-04.pdf
442. NV_BillingGuidelines_PT55_20200518.pdf
... provider. Note: PT 55 procedure codes are carved out of Managed Care (MCO) and services are paid out of FFS. (T2020 and T2017, ...
Terms matched: 1  -  Score: 20  -  15 Mar 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT55_20200518.pdf
443. NV_BillingGuidelines_PT55.pdf
... provider. Note: PT 55 procedure codes are carved out of Managed Care (MCO) and services are paid out of FFS. (T2020 and T2017, ...
Terms matched: 1  -  Score: 20  -  23 Mar 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT55.pdf
444. FFS_DUR_Binder_April_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: 66  -  26 Mar 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FFS_DUR_Binder_April_2021.pdf
445. 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
446. Anthem_DUR_Binder_April_2021.pdf
... Presentation Presented to NV DUR Board on April 22, 2021 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 103  -  02 Apr 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Anthem_DUR_Binder_April_2021.pdf
447. SilverSummit_DUR_Binder_April_2021.pdf
... Reports â€" 32 Multiple Sclerosis Agents Clinical Presentations 3 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 100  -  02 Apr 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/SilverSummit_DUR_Binder_April_2021.pdf
448. Health_Plan_of_Nevada_DUR_Binder_April_2021.pdf
... Drug Use Review Board Meeting APRIL 22, 2021 2021 3 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 94  -  02 Apr 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Health_Plan_of_Nevada_DUR_Binder_April_2021.pdf
449. NV_BillingGuidelines_PT55_20210315.pdf
... provider. Note: PT 55 procedure codes are carved out of Managed Care (MCO) and services are paid out of FFS. (T2020 and T2017, ...
Terms matched: 1  -  Score: 20  -  12 Apr 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT55_20210315.pdf
450. NMO-3430A_Instructions.pdf
... agency as listed below. 5. Any person who fills out the form must choose only one event, not multiple events. The description of the event can ...
Terms matched: 1  -  Score: 14  -  06 May 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NMO-3430A_Instructions.pdf
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