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 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.

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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


Billing Information

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.

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]

Submitting Claims with Other Insurance (Third Party Liability) Frequently Asked Questions (FAQs) [Review Now]


COVID-19 Billing Guides Archives Click here


Remittance Advice Reference Material
Title Last Update
Claim Error/EOB/ANSI Code Crosswalk 08/05/2026
Accounts Receivable Financial Reason Codes 10/09/2020

Billing Manual
For Archives Click here

Title File Size Last Update
Billing Manual 2 MB 07/10/2026

Billing Guidelines (by Provider Type)
For Archives Click here

Provider Type Title Last Update
10 Outpatient Surgery, Hospital Based | Rates 07/27/26
11 Hospital, Inpatient 07/27/26
12 Hospital, Outpatient 07/27/26
13 Psychiatric Hospital, Inpatient 07/27/26
14 Behavioral Health Outpatient Treatment | Outpatient Mental Health Treatment Plan Fact Sheet 07/21/26
15 Registered Dietitian 07/27/26
16 Intermediate Care Facilities for Individuals with Intellectual Disabilities / Public 07/27/26
17 Special Clinics 07/27/26
17 (Spec. 169) Special Clinics: Freestanding Birthing Centers 07/27/26
17 (Spec. 179) Special Clinics: School Based Health Centers (SBHC) 07/27/26
17 (Spec. 181) Special Clinics: Federally Qualified Health Centers (FQHC) 08/10/26
17 (Spec. 188) Special Clinics: Certified Community Behavioral Health Center (CCBHC) | CCBHC Allowable Services | FQHC-CCBHC Allowable Services 07/27/26
19 Nursing Facility 07/27/26
20 Physician, M.D., Osteopath, D.O. 07/27/26
20 (Spec. 699) Children’s Cancer and Rare Diseases Clinic 07/27/26
21 Podiatrist 07/27/26
22 Dentist | Attachment A: Fee-for-Service Coverage, Limitations and Prior Authorization Requirements | Attachment B: Fee-for-Service Coverage, Limitations and Prior Authorization Requirements for Dental Services for the Waiver for Individuals with Intellectual and Developmental Disabilities 07/01/26
23 Hearing Aid Dispenser & Related Supplies 07/27/26
24 Advanced Practice Registered Nurses 07/27/26
25 Optometrist 07/27/26
26 Psychologist 07/27/26
27 Radiology and Non-invasive Diagnostic Centers 07/27/26
28 Pharmacy: Billing Manual n/a
29 Home Health Agency and Private Duty Nursing Services 07/27/26
30 Personal Care Services - Provider Agency 08/11/26
32 (Spec. 249) Community Paramedicine 07/27/26
32 (Spec. 932) Ambulance, Air or Ground 07/27/26
33 Durable Medical Equipment (DME), Disposable, Prosthetics 07/30/26
34 Therapy 07/27/26
35 (Spec. 987) Non-Emergency Secure Behavioral Health Transports 07/27/26
36 Chiropractor 07/27/26
38 Waiver for Individuals with Intellectual and Developmental Disabilities | Attachment A: Variable Services Procedure Codes for Waiver for Individuals with Intellectual and Developmental Disabilities 07/27/26
39 Adult Day Health Care 07/27/26
41 Optician, Optical Business 07/27/26
43 Laboratory, Pathology Clinical 07/27/26
44 Swing-bed, Acute Hospital 07/27/26
45 End Stage Renal Disease (ESRD) Facility 07/27/26
46 Ambulatory Surgical Centers 07/27/26
47 Indian Health Services (IHS) and Tribal Clinics 07/27/26
48 Home and Community Based Waiver for the Frail Elderly 07/27/26
51 Indian Health Service Hospital, Inpatient (Tribal) 07/27/26
52 Indian Health Service Hospital, Outpatient (Tribal) 07/27/26
54 Targeted Case Management 07/27/26
55 (Spec.315) Day Habilitation 07/27/26
55 (Spec.316) Residential Habilitation 07/27/26
56 Inpatient Rehabilitation and Long Term Acute Care (LTAC) Specialty Hospitals 07/27/26
57 Home and Community Based Waiver for the Frail Elderly in Residential Facilities for Groups 07/27/26
58 Home and Community Based Waiver for Persons with Physical Disabilities 07/27/26
59 Home and Community Based Waiver for the Frail Elderly in an Assisted Living Facility 07/27/26
60 School Health Services (SHS) 07/27/26
63 Psychiatric Residential Treatment Facility (PRTF) 08/06/26
64 Hospice 07/27/26
65 Hospice, Long Term Care 07/27/26
68 Intermediate Care Facilities for Individuals with Intellectual Disabilities / Private 07/27/26
72 Nurse Anesthetist 07/27/26
74 Nurse Midwife 07/27/26
75 Critical Access Hospital (CAH), Inpatient 07/27/26
76 Audiologist 07/27/26
77 Physician's Assistant 07/27/26
78 Indian Health Service Hospital, Inpatient (Non-Tribal) 07/27/26
79 Indian Health Service Hospital, Outpatient (Non-Tribal) 07/27/26
81 Hospital Based ESRD Provider 07/27/26
82 Behavioral Health Rehabilitative Treatment 07/27/26
83 Personal Care Services - Intermediary Service Organization 08/11/26
85 Applied Behavior Analysis (ABA) 07/27/26
85 (Spec. 320) Health Home for Beneficiaries with Fetal Alcohol Spectrum Disorder | Health Home for Beneficiaries with Fetal Alcohol Spectrum Disorder Eligibility Checklist 07/27/26
86 Specialized Foster Care | Specialized Foster Care Needs Based Eligibility Checklist 07/27/26
87 Crisis Services 07/27/26
89 Community Health Workers 07/27/26
90 Doula Services 07/27/26
91 Pharmacist 07/27/26
93 (Spec. 704) Residential Substance Use Treatment in an Institution for Mental Disease 07/31/26
93 (Spec. 707) Substance Use Treatment Clinic 07/31/26
93 (Spec. 708) Opioid Treatment Program 07/31/26
95 Home and Community Based Waiver for Structured Family Caregiving 07/27/26
96 Rural Emergency Hospital (REH), Outpatient 07/27/26
97 Peer Support Services 07/27/26

Billing Instructions (by Service Type)
Title Last Update
Anesthesia 08/03/26
Emergency Medicaid Only (EMO) 08/03/26
Justice Involved Reentry Initiative 08/03/26
Medication-Assisted Treatment (MAT) Services for Opioid Dependence 08/03/26
Pregnancy Presumptive Eligibility 08/03/26
Preventive Services 08/03/26
Sterilization and Abortion Policy 08/03/26
Telehealth 08/03/26