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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451. Antipsychotics_Atypical_2021-06.pdf
... 2021. • Stovall J. Bipolar mania and hypomania in adults: choosing pharmacotherapy. UpToDate website. www.uptodate.com/ . Updated April 11, 2021. ...
Terms matched: 1  -  Score: 10  -  06 May 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Antipsychotics_Atypical_2021-06.pdf
452. NV_BillingGuidelines_PT28_20210526.pdf
... . 15 3.14 Drugs Covered Under Fee-for-Service Medicaid for Recipients with Medicaid Managed Care (MCO Carve Out) .... 17 3.15 Medicare Part D Plan (PDP) ...
Terms matched: 1  -  Score: 44  -  01 Jun 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT28_20210526.pdf
453. NV_BillingGuidelines_PT28_20210331.pdf
... . 15 3.14 Drugs Covered Under Fee-for-Service Medicaid for Recipients with Medicaid Managed Care (MCO Carve Out) .... 17 3.15 Medicare Part D Plan (PDP) ...
Terms matched: 1  -  Score: 44  -  01 Jun 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT28_20210331.pdf
454. NV_BillingGuidelines_PT29_online_20191125.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: 36  -  01 Jun 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT29_online_20191125.pdf
455. Quick_Tip_Guide_Inpatient_Psychiatric_and_RTC.pdf
... denied first at the acute level of care. • Should the provider choose to not appeal they may request these dates of service at a lower level ...
Terms matched: 1  -  Score: 20  -  07 Jun 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Quick_Tip_Guide_Inpatient_Psychiatric_and_RTC.pdf
456. E-Binder_SSSB_June_2021.pdf
... 2021. • Stovall J. Bipolar mania and hypomania in adults: choosing pharmacotherapy. UpToDate website. www.uptodate.com/ . Updated April 11, 2021. ...
Terms matched: 1  -  Score: 10  -  09 Jun 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/E-Binder_SSSB_June_2021.pdf
457. Anthem_DUR_Binder_July_2021.pdf
... Presentation Presented to NV DUR Board on July 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: 35  -  15 Jun 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Anthem_DUR_Binder_July_2021.pdf
458. Health_Plan_of_Nevada_DUR_Binder_July_2021.pdf
... Drug Use Review Board Meeting JULY 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: 31  -  15 Jun 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Health_Plan_of_Nevada_DUR_Binder_July_2021.pdf
459. SilverSummit_DUR_Binder_July_2021.pdf
... â€" 16 Antimigraine Medications - Miscellaneous 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: 35  -  15 Jun 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/SilverSummit_DUR_Binder_July_2021.pdf
460. NV_BillingGuidelines_PT35_Spec_987.pdf
... legal or voluntary hold. All Nevada Medicaid recipients, including Managed Care Organization (MCO) enrolled recipients, are eligible if the above conditions are met. The ...
Terms matched: 1  -  Score: 44  -  19 Jul 2021  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT35_Spec_987.pdf
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