Nevada Medicaid and Nevada Check Up News (Third Quarter 2019 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]


Urgent Notification:
Currently, some providers submitting Group Applications, Group Changes and Group Revalidations do not have the option in the Online Provider Enrollment system to select associated providers or change individual providers associated with the group. This is a known issue and a fix is being researched. In the meantime, providers can complete the Associate Provider list and submit it with the request. Individual applications are not impacted by this issue. The Associate Provider list is available at the following link:

Known Modernization System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for August 2019 Claims. See Web Announcement 1979.

Paper claims are no longer accepted by Nevada Medicaid. Please refer to Web Announcement 1733 and Web Announcement 1829 for additional information.

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 and the Billing Guide for your provider type at

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

8:00PM - 12:00AM

Effective February 1, 2019, all providers will be required to submit their claims electronically (using Trading Partners or Direct Data Entry [DDE]), as paper claims submission will no longer be accepted with the go-live of the new modernized Medicaid Management Information System (MMIS). Please continue to review the modernization-related web announcements at for further details.

Attention All Providers: Requirements on When to Use the National Provider Identifier (NPI) of an Ordering, Prescribing or Referring (OPR) Provider on Claims [Web Announcement 1711]

FAQs: National Correct Coding Initiative (NCCI) Claim Review Edits [Review Now]

Clinical Claim Editor FAQs Updated December 5, 2011 [Review Now]

Third Party Liability Frequently Asked Questions [Review Now]

Billing Manual
For Archives Click here

Title File Size Last Update
Billing Manual 2 MB 03/18/2019

Billing Guidelines (by Provider Type)
For Archives Click here

Provider Type Title Last Update
10 Outpatient Surgery, Hospital Based | Rates 01/25/19
11 Hospital, Inpatient 01/31/19
12 Hospital, Outpatient 01/31/19
13 Psychiatric Hospital, Inpatient 02/28/19
14 Behavioral Health Outpatient Treatment | Outpatient Mental Health Treatment Plan Fact Sheet 05/08/19
15 Registered Dietitian 01/25/19
16 Intermediate Care Facilities for Individuals with Intellectual Disabilities / Public 01/25/19
17 Special Clinics 02/01/19
17 (Spec. 179) Special Clinics: School Based Health Centers (SBHC) 01/25/19
17 (Spec. 181) Special Clinics: Federally Qualified Health Centers (FQHC) 08/30/19
17 (Spec. 188) Special Clinics: Certified Community Behavioral Health Center (CCBHC) | CCBHC Allowable Services | FQHC-CCBHC Allowable Services 10/22/19
17 (Spec. 215) Special Clinics: Substance Abuse Agency Model (SAAM) 02/01/19
19 Nursing Facility 01/31/19
20 Physician, M.D., Osteopath, D.O. 10/02/19
21 Podiatrist 06/27/18
22 Dentist | Attachment A: Fee-for-Service Coverage, Limitations and Prior Authorization Requirements 04/10/19
23 Hearing Aid Dispenser & Related Supplies 01/03/13
24 Advanced Practice Registered Nurses 10/02/19
25 Optometrist 10/04/19
26 Psychologist 08/23/19
27 Radiology & Non-invasive Diagnostic Centers 01/31/19
28 Pharmacy: Billing Manual | Apx. A | Apx. B | Apx. C | Apx. D | Apx. E 12/28/18
29 Home Health Agency and Private Duty Nursing Services 07/01/19
30 Personal Care Services - Provider Agency 01/31/19
32 (Spec. 249) Community Paramedicine 11/04/19
32 (Spec. 932) Ambulance, Air or Ground 11/04/19
33 Durable Medical Equipment (DME), Disposable, Prosthetics 06/17/19
34 Therapy 05/23/19
36 Chiropractor 12/05/11
38 Waiver for Individuals with Intellectual and Developmental Disabilities 10/03/19
39 Adult Day Health Center 01/31/19
41 Optician, Optical Business 10/04/19
43 Laboratory, Pathology Clinical 01/31/19
44 Swing-bed, Acute Hospital 01/31/19
45 End Stage Renal Disease (ESRD) Facility 09/05/19
46 Ambulatory Surgical Centers 01/31/19
47 Indian Health Services (IHS) and Tribal Clinics 10/02/15
48 Home and Community Based Waiver for the Frail Elderly 01/31/19
51 Indian Health Service Hospital, Inpatient (Tribal) 12/05/11
52 Indian Health Service Hospital, Outpatient (Tribal) 12/05/11
54 Targeted Case Management 01/31/19
55 Home Based Habilitation Services 09/25/18
56 Inpatient Rehabilitation and Long Term Acute Care (LTAC) Specialty Hospitals 01/31/19
57 Home and Community Based Waiver for the Frail Elderly (Elderly in Adult Residential Care) 01/31/19
58 Home and Community Based Waiver for Persons with Physical Disabilities 01/31/19
59 Home and Community Based Waiver for the Frail Elderly (Augmented Personal Care Services) 01/31/19
60 School Based 02/21/19
63 Residential Treatment Centers (RTC) 04/29/19
64 Hospice 01/31/19
65 Hospice, Long Term Care 01/31/19
68 Intermediate Care Facilities for Individuals with Intellectual Disabilities / Private 01/25/19
72 Nurse Anesthetist 12/05/11
74 Nurse Midwife 05/31/19
75 Critical Access Hospital (CAH), Inpatient 02/01/19
76 Audiologist 01/03/13
77 Physician's Assistant 10/02/19
78 Indian Health Service Hospital, Inpatient (Non-Tribal) 12/05/11
79 Indian Health Service Hospital, Outpatient (Non-Tribal) 12/05/11
81 Hospital Based ESRD Provider 09/05/19
82 Behavioral Health Rehabilitative Treatment 02/01/19
83 Personal Care Services - Intermediary Service Organization 01/31/19
85 Applied Behavior Analysis (ABA) 02/01/19

Billing Instructions (by Service Type)
Title Last Update
Anesthesia 01/24/19
Preventive Services 12/20/18
Sterilization and Abortion Policy 01/24/19
Telehealth 11/15/18