Nevada Medicaid and Nevada Check Up News (Second 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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IMPORTANT: Nevada Medicaid is conducting a swift revalidation effort on high risk providers. If selected, you will receive a revalidation notice with instructions through the standard communication process. See Web Announcement 3935 for more information.

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for July 2026 Professional Claims. See Web Announcement 3983.

Top Prior Authorization Denial Reasons for the Second Quarter of 2026. See Web Announcement 3978.

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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491. NV_BillingGuidelines_PT28_20211228.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: 39  -  04 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT28_20211228.pdf
492. SilverSummit_DUR_Binder_January_2022.pdf
... DUR Reports â€" 41 CGRP Antagonists 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: 115  -  06 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/SilverSummit_DUR_Binder_January_2022.pdf
493. Anthem_DUR_Binder_January_2022.pdf
... Presentation Presented to NV DUR Board on January 27, 2022 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 115  -  06 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Anthem_DUR_Binder_January_2022.pdf
494. FFS_DUR_Survey_FFY2020.pdf
... presented many challenges to State's in terms of drug coverage, meetings, and ___ MCO(s ) (Insert program monitoring. Nevada 3 the number Medicaid of ...
Terms matched: 1  -  Score: 88  -  06 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FFS_DUR_Survey_FFY2020.pdf
495. FFS_DUR_Binder_January_2022.pdf
... biologic agents, it is reasonable to choose gradual step therapy with 5-ASA. â ... if they would like to change their MCO enrollment. Dr. Capurro informed the ...
Terms matched: 2  -  Score: 21  -  06 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FFS_DUR_Binder_January_2022.pdf
496. Health_Plan_of_Nevada_DUR_Binder_January_2022.pdf
... Drug Use Review Board Meeting JANUARY 27, 2022 2022 3 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 113  -  11 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Health_Plan_of_Nevada_DUR_Binder_January_2022.pdf
497. NMO_5006E-S_MCO_Change_Form.pdf
... Nevada Medicaid and Nevada Check Up â€" Managed Care Organization(MCO) Change Form If you would like to request a change to your MCO, ...
Terms matched: 1  -  Score: 286  -  12 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NMO_5006E-S_MCO_Change_Form.pdf
498. web_announcement_2655_20211215.pdf
... Announcement 2655 Attention All Providers: Recipients May Request to Change Managed Care Organization (MCO) Plans In December, Medicaid recipients who are members of Managed Care Organizations ...
Terms matched: 1  -  Score: 186  -  20 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2655_20211215.pdf
499. web_announcement_2683_20220114.pdf
... Attention All Providers: Notify Medicaid Recipients to Act Immediately if They Wish to Switch MCO Plans Nevada Medicaid recipients who wish to change Managed Care Organization (MCO) ...
Terms matched: 1  -  Score: 126  -  20 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2683_20220114.pdf
500. web_announcement_2657_20211216.pdf
... providers and • Home Health Care providers The four Managed Care Organization (MCO) vendors will not be notified of their assigned membership in time to communicate ...
Terms matched: 1  -  Score: 117  -  20 Jan 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2657_20211216.pdf
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