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.

During this time:
  • New enrollment applications cannot be started.
  • Revalidation and Update applications will remain available; and
  • Previously started applications can still be accessed and resumed.

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.

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 dhcfp.nv.gov and the Billing Guide for your provider type at www.medicaid.nv.gov.

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471. E-Binder_SSSB_March_2022.pdf
... qualified health care professionals. She commented that they believe prescribers should be permitted to choose the most appropriate agent without prior authorization (PA) as it can worsen ...
Terms matched: 1  -  Score: 34  -  22 Mar 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/E-Binder_SSSB_March_2022.pdf
472. newsletter_v3i4.pdf
... . Page 2 FALL 2006 Nevada Medicaid News DHCFP Awards New Managed Care Organization (MCO) Contracts The Division of Health Care Financing If you ha ve any que ...
Terms matched: 1  -  Score: 33  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/newsletter_v3i4.pdf
473. E-Binder_SSSB_Dec_2020.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: 32  -  10 Nov 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/E-Binder_SSSB_Dec_2020.pdf
474. E-Binder_SSSB_Jan_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: 32  -  17 Dec 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/E-Binder_SSSB_Jan_2021_.pdf
475. E-Binder_SSSB_June_2020.pdf
... 2020. • Stovall J. Bipolar mania and hypomania in adults: choosing pharmacotherapy. UpToDate website. 2020[b ] . www.uptodate.com/ . Accessed ...
Terms matched: 1  -  Score: 32  -  15 May 2020  -  URL: https://www.medicaid.nv.gov/Downloads/provider/E-Binder_SSSB_June_2020.pdf
476. NV_Flex_User_Guide_Getting_Started.pdf
... .... 16 Forgot Password â€" Delegate .... 18 Forgot Password - MCO .... 22 Forgot Password - Trading Partner .... 24 1.5. Expired ...
Terms matched: 1  -  Score: 32  -  18 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Flex_User_Guide_Getting_Started.pdf
477. NV_BillingGuidelines_PT75_online_020119.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  -  16 Dec 2019  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT75_online_020119.pdf
478. NV_BillingGuidelines_PT75_online_031424.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  -  06 May 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT75_online_031424.pdf
479. 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
480. NV_BillingGuidelines_PT75_online_121619.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  -  14 Mar 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT75_online_121619.pdf
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