All Insurance Policy Changes (Page 111)

Continuing from page 110. Showing older policy changes tracked across all payers. Use the filters in the related-hubs section below to narrow by provider, state, or specialty.

Medium impact
Attention All Providers: Top Prior Authorization Denial Reasons for the Fourth Quarter of 2025
Nevada Medicaid·Identified Jun 21, 2026
Nevada Medicaid published the top 6 reasons for prior authorization denials in Q4 2025, including failure to meet medical necessity criteria, missing additional information, patient eligibility issues, late submissions, invalid forms, and missed reconsideration deadlines. This provides guidance to help providers avoid future PA denials.
Medium impact
Attention Provider Types 19 (Nursing Facility) and 65 (Hospice, Long Term Care): State Fiscal Year 2026 Quarter 3 Rate Updates Implemented
Nevada Medicaid·Effective Jan 1, 2026
Nevada Medicaid has implemented new reimbursement rates for nursing facilities and hospice/long-term care providers effective January 1, 2026. Claims with dates of service on or after this date that were paid at previous rates will be automatically reprocessed at the new rates.
Low impact
Attention Provider Types 11 (Hospital, Inpatient) and 75 (Critical Access Hospital): Hospital Presumptive Eligibility (HPE) Training Calendar Dates and Sign-Up Guidelines
Nevada Medicaid·Identified Jun 21, 2026
Nevada Medicaid requires Hospital Presumptive Eligibility (HPE) staff at hospitals and critical access hospitals to recertify every two years through mandatory 3-day virtual training sessions. Training registration must be completed and approved 10 business days before each session.
Medium impact
Attention Provider Types 20 (Physician, M.D., Osteopath, D.O.), 24 (Advanced Practice Registered Nurses), 26 (Psychologist), and 77 (Physician’s Assistant): Behavioral Health Procedure Codes Open for Billing
Nevada Medicaid·Effective Feb 9, 2026
Nevada Medicaid has opened specific behavioral health procedure codes for billing by physicians, APRNs, psychologists, and physician assistants effective February 9, 2026. The newly billable codes include multiple-family group psychotherapy, alcohol/drug assessments, telehealth fees, and intensive outpatient psychiatric services, with specific service limitations and prior authorization requirements.
High impact
Attention Provider Types (PT) 14/300 (Behavioral Health Outpatient Treatment) and PT 82/300 (Behavioral Health Rehabilitative Treatment): Qualified Mental Health Professionals (QMHP) Will Be Limited To Clinical Interns Only
Nevada Medicaid·Effective Feb 9, 2026
Nevada Medicaid has restricted Qualified Mental Health Professional (QMHP) enrollment under provider types 14/300 and 82/300 to clinical interns only. Fully licensed professionals must now enroll under their specific provider type and specialty codes instead of the general QMHP categories.
Low impact
Family Navigation Network Event Scheduled for March 6, 2026, and March 7, 2026
Nevada Medicaid·Identified Jun 21, 2026
Nevada Medicaid announced a Family Navigation Network event on March 6-7, 2026, to support youth with disabilities and special healthcare needs transitioning to adulthood. This is an informational announcement about a professional development opportunity with no billing or policy changes.
Medium impact
Medicaid Services Manual Chapters Updated
Nevada Medicaid·Effective Jan 1, 2026
Nevada Medicaid updated three manual chapters effective January 1, 2026: Mental Health Services now covers Rehabilitative Residential Mental Health Care services, Transportation Services expanded to include Nevada Check Up recipients for non-emergency medical transportation, and Managed Care Organization chapter aligned with new statewide managed care contracts.
High impact
Attention All Behavioral Health Providers: Assessment Type Names for Behavioral Health Prior Authorizations (PA)
Nevada Medicaid·Effective Dec 15, 2025
Nevada Medicaid updated the assessment type names in their Provider Web Portal for behavioral health prior authorization requests. Providers must now select the correct updated assessment type names (CALOCUS instead of CASII, etc.) or risk technical denials of their PA requests.
Low impact
Children’s Dental Health Month Resources for Primary Care Physicians & Pediatricians
Nevada Medicaid·Effective Feb 11, 2026
Nevada Medicaid released educational resources for Children's Dental Health Month to help primary care physicians and pediatricians incorporate oral health discussions into well-child visits. This is an informational announcement providing guidance on preventive oral health care rather than a billing policy change.
Medium impact
Attention Provider Type 34 (Therapy) Specialties 027 (Physical Therapy) and 028 (Occupational Therapy): Update On Claims for Procedure Codes 97129, 97130, and 97533
Nevada Medicaid·Effective Feb 9, 2026
Nevada Medicaid has fixed a system error that was incorrectly denying claims for cognitive therapy and sensory integration procedures (CPT codes 97129, 97130, and 97533) from physical and occupational therapy providers. Claims with dates of service from January 1, 2026 that were previously denied will be automatically reprocessed for payment.
Medium impact
Attention All Providers: Top Claim Denial Reasons and Resolutions/Workarounds for January 2026 Professional Claims
Nevada Medicaid·Effective Feb 12, 2026
Nevada Medicaid has published the top 9 claim denial reasons from January 2026 with specific resolution steps. This guidance helps providers understand common billing errors including Medicare crossover issues, coverage verification problems, duplicate claims, and eligibility verification failures.
High impact
2026 Annual New Code Update
Nevada Medicaid·Effective Jan 1, 2026
Nevada Medicaid has added 2026 CPT, HCPCS, and ADA codes to their system effective January 1, 2026, but rates are still being updated. Claims with 2026 codes will suspend with error code 853 until rates and policies are finalized, and retroactive prior authorization requests will be allowed during this transition period.
Medium impact
Error Code 5074 Has Been Updated for Drug Claims with Modifier JW
Nevada Medicaid·Effective Feb 9, 2026
Nevada Medicaid has fixed error code 5074 that was incorrectly denying single-use drug claims when the same NDC was billed with and without modifier JW on the same date. Claims with drug wastage (modifier JW) will no longer be denied for this reason, and previously denied claims will be automatically reprocessed.
Low impact
New Specialty 320 (Medicaid Health Home for Beneficiaries with Fetal Alcohol Spectrum Disorder [FASD]) Under Provider Type 85 (Applied Behavior Analysis) is Available for Enrollment
Nevada Medicaid·Effective Oct 1, 2025
Nevada Medicaid has opened enrollment for a new specialty 320 under Provider Type 85 (Applied Behavior Analysis) specifically for providers serving beneficiaries with Fetal Alcohol Spectrum Disorder through Medicaid Health Home services. Eligible providers can backdate enrollment to October 1, 2025, and must submit a PT 85 Specialty 320 Eligibility Checklist with their first claim for each recipient.
Medium impact
Instructions Updated for Resetting Provider Web Portal and Provider Flex Passwords
Nevada Medicaid·Effective Feb 17, 2026
Nevada Medicaid has changed their password reset process for Provider Web Portal and Provider Flex accounts. Passwords will no longer be sent via email; instead, users receive a secure link to verify identity and reset passwords themselves.
Medium impact
Attention All Providers: Prior Authorization Notice of Decision Letters Are No Longer Mailed
Nevada Medicaid·Effective Feb 18, 2026
Effective February 18, 2026, Nevada Medicaid will no longer mail Notice of Decision letters for prior authorization determinations to providers. Providers must now access PA decisions through the Provider Web Portal using the Report Download feature.
Medium impact
Attention All Behavioral Health Providers: Assessment Type Age Restrictions Removed from the Provider Web Portal for Prior Authorization Requests
Nevada Medicaid·Effective Feb 17, 2026
Nevada Medicaid has removed age restrictions from the Provider Web Portal's prior authorization submission form for behavioral health services, effective February 17, 2026. Providers must now manually ensure they select the correct assessment type (CALOCUS, LOCUS, or ECSII) based on patient age, as incorrect selections will result in PA denials.
Medium impact
Attention Provider Type 74 (Nurse Midwife): Sleep Codes G0398, G0399 and G0400 Cannot Be Billed
Nevada Medicaid·Effective Feb 23, 2026
Nevada Medicaid has corrected an error that previously allowed Nurse Midwives (Provider Type 74) to bill sleep study codes G0398, G0399, and G0400. These codes are now properly denied for this provider type and cannot be billed going forward.
Low impact
Attention All Providers, Delegates and Staff: Upcoming Training Sessions for March 2026
Nevada Medicaid·Identified Jun 21, 2026
Nevada Medicaid has announced 10 training sessions for March 2026 covering topics like new provider orientation, claims submission, enrollment processes, and specialty-specific workshops. These are educational opportunities for providers, delegates, and staff to improve their understanding of Nevada Medicaid processes.
Medium impact
Attention Provider Type 29 (Home Health Agency and Private Duty Nursing Services): Clarification of Web Announcement 3795
Nevada Medicaid·Effective Feb 26, 2026
Nevada Medicaid corrected a previous announcement stating that Private Duty Nursing (PDN) services must be terminated when a recipient is hospitalized for 24+ hours. Providers may now choose to suspend rather than terminate services during hospitalization, but cannot bill for dates when the recipient is hospitalized and not receiving PDN services.
Low impact
Join Us for a Live Webinar on ABA Insurance Coverage in Nevada
Nevada Medicaid·Effective Mar 17, 2026
Nevada is hosting a live webinar on March 17, 2026, to discuss Applied Behavior Analysis (ABA) insurance coverage options across Medicaid, private insurance, and SSHIX plans. This is an informational session for families, caregivers, and professionals to learn about coverage and share community input.
Medium impact
Attention Provider Types 10 (Outpatient Surgery, Hospital Based), 12 (Hospital, Outpatient), and 46 (Ambulatory Surgical Centers): Procedure Codes C1767 and C1778 Opened for Billing
Nevada Medicaid·Effective Mar 1, 2026
Nevada Medicaid now allows billing for vagus nerve stimulation (VNS) therapy device codes C1767 and C1778 for refractory epilepsy treatment by outpatient surgery centers, hospitals, and ambulatory surgical centers. These devices will be reimbursed at 82% of acquisition cost and require prior authorization plus specific refractory epilepsy diagnosis codes.
Low impact
New Specialties to be Created Under Provider Type 87 (Crisis Services) for Mobile Crisis Team and Intensive Crisis Stabilization Services
Nevada Medicaid·Effective Mar 16, 2026
Nevada Medicaid is creating two new specialties under provider type 87 (Crisis Services): specialty 033 for Mobile Crisis Team services and specialty 034 for Intensive Crisis Stabilization Services. Providers can enroll starting March 16, 2026, with the ability to backdate enrollment to October 1, 2025.
Medium impact
Attention Provider Types 20 (Physician, M.D., Osteopath, D.O.), 25 (Optometrist) and 41 (Optician, Optical Business): Billing Instructions for Combining Lens-Related Vision Codes
Nevada Medicaid·Effective Nov 1, 2024
Nevada Medicaid has established new billing limitations for lens-related vision codes, restricting bifocal/trifocal width codes and prism add-on codes to 2 units per rolling year each, with treatment and coating codes having individual 2-unit limits. Claims previously denied with error code 5585 will be automatically reprocessed.
Medium impact
Claims That Denied with Error Code 6511 Have Been Reprocessed
Nevada Medicaid·Effective Mar 3, 2026
Nevada Medicaid has automatically reprocessed claims that incorrectly denied with error code 6511 (Add-on code billed without primary) for dates of service from January 1, 2026 through February 18, 2026. Results of reprocessed claims will appear on the March 13, 2026 remittance advice.

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Archive by year

2023 2024 2025 2026

Attention All Providers: Top Prior Authorization Denial Reasons for the Fourth Quarter of 2025

Attention Provider Types 19 (Nursing Facility) and 65 (Hospice, Long Term Care): State Fiscal Year 2026 Quarter 3 Rate Updates Implemented

Attention Provider Types 11 (Hospital, Inpatient) and 75 (Critical Access Hospital): Hospital Presumptive Eligibility (HPE) Training Calendar Dates and Sign-Up Guidelines

Attention Provider Types 20 (Physician, M.D., Osteopath, D.O.), 24 (Advanced Practice Registered Nurses), 26 (Psychologist), and 77 (Physician’s Assistant): Behavioral Health Procedure Codes Open for Billing

Attention Provider Types (PT) 14/300 (Behavioral Health Outpatient Treatment) and PT 82/300 (Behavioral Health Rehabilitative Treatment): Qualified Mental Health Professionals (QMHP) Will Be Limited To Clinical Interns Only

Family Navigation Network Event Scheduled for March 6, 2026, and March 7, 2026

Medicaid Services Manual Chapters Updated

Attention All Behavioral Health Providers: Assessment Type Names for Behavioral Health Prior Authorizations (PA)

Children’s Dental Health Month Resources for Primary Care Physicians & Pediatricians

Attention Provider Type 34 (Therapy) Specialties 027 (Physical Therapy) and 028 (Occupational Therapy): Update On Claims for Procedure Codes 97129, 97130, and 97533

Attention All Providers: Top Claim Denial Reasons and Resolutions/Workarounds for January 2026 Professional Claims

2026 Annual New Code Update

Error Code 5074 Has Been Updated for Drug Claims with Modifier JW

New Specialty 320 (Medicaid Health Home for Beneficiaries with Fetal Alcohol Spectrum Disorder [FASD]) Under Provider Type 85 (Applied Behavior Analysis) is Available for Enrollment

Instructions Updated for Resetting Provider Web Portal and Provider Flex Passwords

Attention All Providers: Prior Authorization Notice of Decision Letters Are No Longer Mailed

Attention All Behavioral Health Providers: Assessment Type Age Restrictions Removed from the Provider Web Portal for Prior Authorization Requests

Attention Provider Type 74 (Nurse Midwife): Sleep Codes G0398, G0399 and G0400 Cannot Be Billed

Attention All Providers, Delegates and Staff: Upcoming Training Sessions for March 2026

Attention Provider Type 29 (Home Health Agency and Private Duty Nursing Services): Clarification of Web Announcement 3795

Join Us for a Live Webinar on ABA Insurance Coverage in Nevada

Attention Provider Types 10 (Outpatient Surgery, Hospital Based), 12 (Hospital, Outpatient), and 46 (Ambulatory Surgical Centers): Procedure Codes C1767 and C1778 Opened for Billing

New Specialties to be Created Under Provider Type 87 (Crisis Services) for Mobile Crisis Team and Intensive Crisis Stabilization Services

Attention Provider Types 20 (Physician, M.D., Osteopath, D.O.), 25 (Optometrist) and 41 (Optician, Optical Business): Billing Instructions for Combining Lens-Related Vision Codes

Claims That Denied with Error Code 6511 Have Been Reprocessed