Nevada Medicaid and Nevada Check Up News (First Quarter 2025 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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Provider Flex is coming soon!
For information and training opportunities on this exciting new enrollment tool, please visit our Provider Flex page

Attention Provider Types Not Implemented in Provider Flex:
Please note that the Online Provider Enrollment (OPE) tool will be unavailable to begin any NEW enrollment applications for these provider types from June 30, 2025 – July 7, 2025. Please refer to Web Announcement 3595 for details.

Multi-Factor Authentication Frequently Asked Questions

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for May 2025 Professional Claims. See Web Announcement 3651.

Top Prior Authorization Denial Reasons for the First Quarter of 2025. See Web Announcement 3630.

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 dhcfp.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 06/09/2025
Accounts Receivable Financial Reason Codes 10/09/2020

Billing Manual
For Archives Click here

Title File Size Last Update
Billing Manual 2 MB 02/20/2025

Billing Guidelines (by Provider Type)
For Archives Click here

Provider Type Title Last Update
10 Outpatient Surgery, Hospital Based | Rates 01/29/25
11 Hospital, Inpatient 05/06/25
12 Hospital, Outpatient 04/18/25
13 Psychiatric Hospital, Inpatient 06/06/25
14 Behavioral Health Outpatient Treatment | Outpatient Mental Health Treatment Plan Fact Sheet 03/05/25
15 Registered Dietitian 12/16/19
16 Intermediate Care Facilities for Individuals with Intellectual Disabilities / Public 11/25/19
17 Special Clinics 04/14/25
17 (Spec. 169) Special Clinics: Freestanding Birthing Centers 10/12/21
17 (Spec. 179) Special Clinics: School Based Health Centers (SBHC) 01/25/19
17 (Spec. 181) Special Clinics: Federally Qualified Health Centers (FQHC) 04/14/25
17 (Spec. 188) Special Clinics: Certified Community Behavioral Health Center (CCBHC) | CCBHC Allowable Services | FQHC-CCBHC Allowable Services 12/06/23
19 Nursing Facility 08/24/23
20 Physician, M.D., Osteopath, D.O. 04/18/25
20 (Spec. 699) Children’s Cancer and Rare Diseases Clinic 07/17/24
21 Podiatrist 01/29/25
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 03/27/23
23 Hearing Aid Dispenser & Related Supplies 12/06/24
24 Advanced Practice Registered Nurses 04/18/25
25 Optometrist 12/18/24
26 Psychologist 03/18/22
27 Radiology and Non-invasive Diagnostic Centers 02/25/20
28 Pharmacy: Billing Manual n/a
29 Home Health Agency and Private Duty Nursing Services 03/18/25
30 Personal Care Services - Provider Agency 01/31/19
32 (Spec. 249) Community Paramedicine 11/04/19
32 (Spec. 932) Ambulance, Air or Ground 12/07/21
33 Durable Medical Equipment (DME), Disposable, Prosthetics 06/23/25
34 Therapy 11/21/23
35 (Spec. 987) Non-Emergency Secure Behavioral Health Transports 07/19/21
36 Chiropractor 12/05/11
38 Waiver for Individuals with Intellectual and Developmental Disabilities | Attachment A: Variable Services Procedure Codes for Waiver for Individuals with Intellectual and Developmental Disabilities 12/27/24
39 Adult Day Health Care 03/09/20
41 Optician, Optical Business 12/18/24
43 Laboratory, Pathology Clinical 04/10/24
44 Swing-bed, Acute Hospital 11/25/19
45 End Stage Renal Disease (ESRD) Facility 02/03/21
46 Ambulatory Surgical Centers 01/29/25
47 Indian Health Services (IHS) and Tribal Clinics 04/22/25
48 Home and Community Based Waiver for the Frail Elderly 06/22/23
51 Indian Health Service Hospital, Inpatient (Tribal) 12/02/19
52 Indian Health Service Hospital, Outpatient (Tribal) 12/02/19
54 Targeted Case Management 06/17/20
55 (Spec.315) Day Habilitation 08/01/24
55 (Spec.316) Residential Habilitation 08/01/24
56 Inpatient Rehabilitation and Long Term Acute Care (LTAC) Specialty Hospitals 12/03/19
57 Home and Community Based Waiver for the Frail Elderly in Residential Facilities for Groups 01/25/21
58 Home and Community Based Waiver for Persons with Physical Disabilities 12/12/22
59 Home and Community Based Waiver for the Frail Elderly in an Assisted Living Facility 05/24/23
60 School Health Services (SHS) 08/28/24
63 Psychiatric Residential Treatment Facility (PRTF) 01/20/22
64 Hospice 01/16/25
65 Hospice, Long Term Care 01/26/23
68 Intermediate Care Facilities for Individuals with Intellectual Disabilities / Private 11/25/19
72 Nurse Anesthetist 12/05/11
74 Nurse Midwife 01/29/25
75 Critical Access Hospital (CAH), Inpatient 05/06/25
76 Audiologist 12/06/24
77 Physician's Assistant 04/18/25
78 Indian Health Service Hospital, Inpatient (Non-Tribal) 12/02/19
79 Indian Health Service Hospital, Outpatient (Non-Tribal) 12/02/19
81 Hospital Based ESRD Provider 02/03/21
82 Behavioral Health Rehabilitative Treatment 04/09/24
83 Personal Care Services - Intermediary Service Organization 01/31/19
85 Applied Behavior Analysis (ABA) 03/04/25
86 Specialized Foster Care | Specialized Foster Care Needs Based Eligibility Checklist 09/21/23
87 (Spec. 031) Designated Mobile Crisis Team (DMCT) 09/03/24
87 (Spec. 032) Designated Mobile Crisis Team Attached to a CCBHC 09/03/24
87 (Spec. 250) Crisis Stabilization Center 09/03/24
89 Community Health Workers 02/19/25
90 Doula Services 11/13/24
91 Pharmacist 08/16/24
93 (Spec. 704) Residential Substance Use Treatment in an Institution for Mental Disease 02/19/25
93 (Spec. 707) Substance Use Treatment Clinic 06/25/25
93 (Spec. 708) Opioid Treatment Program 06/25/25
95 Home and Community Based Waiver for Structured Family Caregiving 04/11/25
96 Rural Emergency Hospital (REH), Outpatient 05/20/25

Billing Instructions (by Service Type)
Title Last Update
Anesthesia 04/21/22
Emergency Medicaid Only (EMO) 02/07/23
Justice Involved Reentry Initiative 01/03/25
Medication-Assisted Treatment (MAT) Services for Opioid Dependence 07/25/24
Preventive Services 05/04/20
Sterilization and Abortion Policy 12/17/24
Telehealth 02/22/23