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]

Notifications

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 June 2026 Professional Claims. See Web Announcement 3964.

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.

Scheduled Site Maintenance

During the scheduled site maintenance window the Provider Web Portal will be unavailable. The table below shows the regularly scheduled maintenance window. All times will be in the Pacific time zone.

Monday - Friday
12:00AM - 12:30AM

Monday
8:00PM - 12:00AM

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... in a Managed Care and/or respiratory therapists’ drawing of Organization (MCO), it is the laboratory’s arterial blood. responsibility to ...
Terms matched: 1  -  Score: 38  -  15 Mar 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43_20101202.pdf
... provider affiliate testing the For recipients enrolled in a Managed Care specimen. Organization (MCO), it is the laboratory’s responsibility to comply with all ...
Terms matched: 1  -  Score: 37  -  15 Mar 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43_20100628.pdf
... in a Managed Care and/or respiratory therapists’ drawing of Organization (MCO), it is the laboratory’s arterial blood. responsibility to ...
Terms matched: 1  -  Score: 38  -  15 Mar 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT43_20110127.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
... Data (Subscriber Information 2100 C Loop) An 820 transaction is created for each MCO and payment for each recipient that is enrolled in the MCO for the following ...
Terms matched: 1  -  Score: 41  -  29 Mar 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Health_Care_Premium_Payment_(820).pdf
... Centers for Medicare & Medicaid Services to reach out to recipients. Each provider, MCO and partner can create their own messaging. English Messaging Spanish Messaging 2. ...
Terms matched: 1  -  Score: 23  -  01 Apr 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_2740_20220317.pdf
... DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on the appropriate agenda, will be presented at the quarterly ...
Terms matched: 1  -  Score: 127  -  04 Apr 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Molina_DUR_Binder_April_2022.pdf
... Reports â€" 22 Movement Disorder 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: 76  -  04 Apr 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/SilverSummit_DUR_Binder_April_2022.pdf
... Presentation Presented to NV DUR Board on April 28, 2022 DRUG USE REVIEW BOARD MCO PRIOR AUTHORIZATION CRITERIA REVIEW FORM Clinical criteria for drugs or drug classes listed on ...
Terms matched: 1  -  Score: 63  -  04 Apr 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Anthem_DUR_Binder_April_2022.pdf
... Drug Use Review Board Meeting APRIL 28, 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: 60  -  04 Apr 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Health_Plan_of_Nevada_DUR_Binder_April_2022.pdf
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