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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551. companionguide834_hipaa-01-12.pdf
... Number REF01 Reference 36 38 = Master Policy Number Identification Qualifier REF02 Reference 36 10-digit MCO Atypical Provider Identification Identifier 1000A N1 Sponsor Name N102 Plan Sponsor Name 39 Division ...
Terms matched: 1  -  Score: 24  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/companionguide834_hipaa-01-12.pdf
552. companionguide834_hipaa.pdf
... Number REF01 Reference 36 38 = Master Policy Number Identification Qualifier REF02 Reference 36 10-digit MCO Atypical Identification Provider Identifier 1000A N1 Sponsor Name N102 Plan Sponsor Name 39 Division ...
Terms matched: 1  -  Score: 24  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/companionguide834_hipaa.pdf
553. E-Binder_PT_June_2018.pdf
... DAA experience patients and retreatment. I’m not here to advocate for choosing one agent over another. All the DAA single tablet regimens have established high ...
Terms matched: 1  -  Score: 24  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/E-Binder_PT_June_2018.pdf
554. Customer_Service_Center_Call_Menu.pdf
... Service Contact Center telephone number above. Please use this script to assist you in choosing the appropriate options. Thank you for calling Nevada Medicaid. All calls may ...
Terms matched: 1  -  Score: 23  -  22 Nov 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Customer_Service_Center_Call_Menu.pdf
555. Multiple_Sclerosis_Agents_2018-11.pdf
... and published resources when making medical decisions. â — ‹ For active RRMS, choosing among the wide range of available drugs from the modestly effective to the highly ...
Terms matched: 1  -  Score: 23  -  09 Oct 2018  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Multiple_Sclerosis_Agents_2018-11.pdf
556. 6_Health_Care_Guidance_Program_2014.pdf
... ) • Those receiving Targeted Case Management (TCM) • MCO enrollees • Nevada Check-Up enrollees (CHIP) • Emergency ...
Terms matched: 1  -  Score: 23  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/6_Health_Care_Guidance_Program_2014.pdf
557. NV_Medicaid_News_2018-0111.pdf
... Benefits Administrator (DBA) to serve recipients enrolled in a Managed Care Organization (MCO) in Washoe and Clark counties. The following information will assist Medicaid dental ...
Terms matched: 1  -  Score: 23  -  11 Jan 2018  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_Medicaid_News_2018-0111.pdf
558. Special Batch and Claim Appeals Final 2013-0826.pdf
... due to system issue • Orthodontic claims â€" recipients enrolled in MCO • Exceptions approved by the Division of Health Care Financing and Policy ...
Terms matched: 1  -  Score: 23  -  15 Jun 2017  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Special%20Batch%20and%20Claim%20Appeals%20Final%202013-0826.pdf
559. Foundations-New Provider Program Basics 2015-0921.pdf
... HP Enterprise Services (HPES) • Nevada Medicaid Managed Care Organizations (MCO) • Questions? 2 Foundations: New Provider Program Basics Department ...
Terms matched: 1  -  Score: 23  -  28 Sep 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/Foundations-New%20Provider%20Program%20Basics%202015-0921.pdf
560. nv_billing_ndc_reference.pdf
... and report NDC data for all drug claims covered by contracted Managed Care Organization (MCO) programs. NDC Breakdown An NDC consists of 11 digits separated into 3 ...
Terms matched: 1  -  Score: 23  -  10 Oct 2022  -  URL: https://www.medicaid.nv.gov/Downloads/provider/nv_billing_ndc_reference.pdf
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