Nevada Medicaid and Nevada Check Up News (Fourth 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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NOTIFICATION: Some Provider Flex services will be temporarily unavailable due to scheduled maintenance from 7 p.m. Pacific Time on Friday, March 6, 2026, to 11 a.m. Pacific Time on Saturday, March 7, 2026.

During this time:
  • New enrollment applications cannot be started.
  • Revalidation and Update applications will remain available; and
  • Previously started applications can still be accessed and resumed.

URGENT NOTIFICATION: Update regarding the Electronic Visit Verification (EVV) claims processing error. Nevada Medicaid did not receive some claims from Sandata (Optum) in time for the February 06, 2026 financial cycle. The issue was resolved this week. EVV providers can contact Sandata Technologies at (833) 545-0394 or support@sandata.com for assistance.

Known System Issues-Click HERE

Top 10 Claim Denial Reasons and Resolutions/Workarounds for January 2026 Professional Claims. See Web Announcement 3840.

Top Prior Authorization Denial Reasons for the Fourth Quarter of 2025. See Web Announcement 3830.

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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1. NV_BillingGuidelines_PT22-attachmentB_01-29-26.pdf
... ) 00 1 unit per 36 months per tooth D2950 Core buildup, including any pins, in addition to 1 unit per 36 months per tooth 00 crown D2951 ...
Terms matched: 1  -  Score: 25  -  02 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB_01-29-26.pdf
2. NV_BillingGuidelines_PT22-attachmentB.pdf
... ) 00 1 unit per 36 months per tooth D2950 Core buildup, including any pins, in addition to 1 unit per 36 months per tooth 00 crown D2951 ...
Terms matched: 1  -  Score: 25  -  02 Feb 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB.pdf
3. NV_BillingGuidelines_PT22-attachmentA.pdf
... 00 00 00 2 units per 6 months per tooth D2950 CORE BUILD-UP INCL ANY PINS 00 02 02 1 unit per 36 months per tooth Updated 01/29 ...
Terms matched: 1  -  Score: 25  -  29 Jan 2026  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentA.pdf
4. NV_BillingGuidelines_PT60.pdf
... Limit of 2 units per 6 months per tooth D2950 Core build-up, including any pins when required. • Limit of 1 unit per 36 months per ...
Terms matched: 1  -  Score: 21  -  16 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60.pdf
5. NV_BillingGuidelines_PT60_2024-0828.pdf
... Limit of 2 units per 6 months per tooth D2950 Core build-up, including any pins when required. • Limit of 1 unit per 36 months per ...
Terms matched: 1  -  Score: 21  -  16 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT60_2024-0828.pdf
6. NV_BillingGuidelines_PT22-attachmentB_12-08-25.pdf
... ) 00 1 unit per 36 months per tooth D2950 Core buildup, including any pins, in addition to 1 unit per 36 months per tooth 00 crown D2951 ...
Terms matched: 1  -  Score: 25  -  15 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB_12-08-25.pdf
7. NV_BillingGuidelines_PT22-attachmentB_10-06-25.pdf
... ) 00 1 unit per 36 months per tooth D2950 Core buildup, including any pins, in addition to 1 unit per 36 months per tooth 00 crown D2951 ...
Terms matched: 1  -  Score: 25  -  08 Dec 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/NV_BillingGuidelines_PT22-attachmentB_10-06-25.pdf
8. FA-24A.pdf
... PM Bathing Dressing Grooming Toileting Transfer/Positioning Mobility/Ambulation Eating Housekeeping Laundry Essential Shopping Meal Preparation FA-24A Page 1 of 2 Updated 07/16/2025 ( ...
Terms matched: 1  -  Score: 21  -  16 Jul 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-24A.pdf
9. FA-24W.pdf
... Positioning â Ambulation â Eating â Meal Preparation â Laundry â Light Housekeeping â Essential Shopping â Other: ____ Is this recipient at risk of institutionalization if services ...
Terms matched: 1  -  Score: 20  -  16 Jul 2025  -  URL: https://www.medicaid.nv.gov/Downloads/provider/FA-24W.pdf
10. web_announcement_3456_20241009.pdf
... go to MyForms to start the process. They will need their case number, PIN and last four digits of the head of household’s Social Security ...
Terms matched: 1  -  Score: 23  -  09 Oct 2024  -  URL: https://www.medicaid.nv.gov/Downloads/provider/web_announcement_3456_20241009.pdf
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