All Insurance Policy Changes (Page 74)

Continuing from page 73. 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 Provider Type 60 (School Health Services): Ordering, Prescribing and Referring Requirements Updated
Nevada Medicaid·Effective Mar 9, 2026
Nevada Medicaid updated ordering, prescribing and referring (OPR) provider requirements for School Health Services providers. Effective March 9, 2026, specific procedure codes will require the ordering provider's NPI on claims or they will be denied, while some codes no longer require OPR provider NPIs as of July 1, 2024.
Low impact
Medicaid Services Manual Chapter 4500 Updated
Nevada Medicaid·Effective Dec 31, 2025
Nevada Medicaid is adding a new benefit for Behavioral Health Training Clinic (BHTC) services through accredited universities, effective December 31, 2025. A new Medicaid Services Manual Chapter 4500 has been created to define service models, eligible providers, covered services, documentation requirements, and billing information for this new benefit.
Medium impact
Attention All Providers: Top 10 Claim Denial Reasons and Resolutions/Workarounds for February 2026 Professional Claims
Nevada Medicaid·Effective Mar 10, 2026
Nevada Medicaid has released their top 10 claim denial reasons for February 2026, providing specific error codes and resolutions for common billing issues including Medicare crossover problems, coverage verification, prior authorization errors, and provider enrollment issues.
Medium impact
Attention Provider Types 24 (Advanced Practice Registered Nurse), 74 (Nurse Midwife), and 77 (Physician’s Assistant): Claims Have Been Reprocessed to Pay Updated Rates
Nevada Medicaid·Effective Jan 1, 2024
Nevada Medicaid has automatically reprocessed claims for Advanced Practice Registered Nurses (PT 24), Nurse Midwives (PT 74), and Physician's Assistants (PT 77) to pay updated rates. Claims with dates of service from January 1, 2024 through October 28, 2024, and crisis intervention services (H2011 with HT modifier) from July 1, 2024 through December 15, 2025 have been reprocessed with results appearing on March 20, 2026 remittance advice.
Medium impact
Attention Provider Type (PT) 19 (Nursing Facilities) and Hospitals under PTs 10, 11, 13, and 14: Pre-Admission Screening and Resident Review (PASRR), Level of Care (LOC), and Nursing Facility Tracking (NFT) Requests Can Be Submitted Under One Profile
Nevada Medicaid·Effective Mar 17, 2026
Nevada Medicaid providers can now submit Pre-Admission Screening and Resident Review (PASRR), Level of Care (LOC), and Nursing Facility Tracking (NFT) requests simultaneously under one profile through the PASRR screening tool. The approval sequence remains unchanged with PASRR requiring approval first before LOC and NFT review.
Medium impact
Attention All Providers: Medicaid ID Cards
Nevada Medicaid·Effective Mar 18, 2026
Nevada Medicaid now requires providers to accept digital Medicaid ID cards and Notice of Decision (NOD) documents as valid proof of coverage. Providers must not turn away members who don't have physical cards and should use the Provider Web Portal to verify eligibility.
Low impact
New Specialties 033 (Mobile Crisis Team) and 034 (Intensive Crisis Stabilization Services) Under Provider Type 87 (Crisis Services) Are Available for Enrollment
Nevada Medicaid·Effective Oct 1, 2025
Nevada Medicaid has opened enrollment for two new crisis service specialties: Mobile Crisis Team (033) and Intensive Crisis Stabilization Services (034) under Provider Type 87. Eligible providers can enroll through Provider Flex and backdate their enrollment to October 1, 2025.
Medium impact
Attention Provider Type 33 (Durable Medical Equipment, Prosthetics, Orthotics and Supplies): Authorization Criteria Updated to Remove Incorrect Requirements
Nevada Medicaid·Effective Mar 16, 2026
Nevada Medicaid corrected an error in their Provider Web Portal that incorrectly stated prior authorization was required for catheter codes A4351, A4352, and A4353 when exceeding 200 units per month. The portal now correctly shows that PA cannot be used to exceed this limit - claims over 200 units will simply be denied.
Medium impact
Medicaid Management Information System Updated with NCCI Quarter 2 2026 Files
Nevada Medicaid·Effective Apr 1, 2026
Nevada Medicaid has updated their system with new NCCI Quarter 2 2026 files containing updated Medically Unlikely Edits (MUE) and Procedure-to-Procedure (PTP) edits. These updates will automatically process claims and prevent improper payments when incorrect code combinations are reported or service limitations are exceeded.
Low impact
Attention All Providers, Delegates and Staff: Upcoming Training Sessions for April 2026
Nevada Medicaid·Identified Jun 21, 2026
Nevada Medicaid has announced provider training sessions for April 2026, covering topics like prior authorization, enrollment, claims submission, and specialty-specific workshops. These are voluntary educational sessions to help providers understand Nevada Medicaid processes and requirements.
Medium impact
Form FA-13A Updated to Rehabilitative Residential Treatment Services Absence Form
Nevada Medicaid·Effective Mar 20, 2026
Nevada Medicaid updated Form FA-13A (RTC Absence Form) to the Rehabilitative Residential Treatment Services Absence Form with terminology changes and expanded provider eligibility. The form language changed from RTC to Psychiatric Residential Treatment Facility (PRTF) and added new provider types for residential mental health services.
Medium impact
Attention Federally Qualified Health Center (FQHC) Providers: Clarification of Pharmacist Codes Billable for Encounters
Nevada Medicaid·Effective Mar 20, 2026
Nevada Medicaid has clarified specific billing codes that pharmacists can use at FQHCs for various services including contraceptives, HIV prevention/treatment, substance abuse screening, and medication-assisted treatment. Some codes require system updates before they can be processed.
Low impact
NOW OPEN: Apply for Nevada’s Rural Health System Flex Fund
Nevada Medicaid·Identified Jun 21, 2026
Nevada has opened the Rural Health System Flex Fund, providing funding opportunities for rural healthcare providers to support capital expenditures and equipment modernization. This is a funding opportunity announcement, not a billing policy change.
Medium impact
Attention Provider Type 22 (Dentist): Veneers Are No Longer Covered for Adults and Pregnant Members
Nevada Medicaid·Effective Mar 23, 2026
Nevada Medicaid will no longer cover dental veneers (codes D2960, D2961, D2962) for adults age 21 and older or pregnant members effective March 23, 2026. Coverage continues for members age 20 and younger only.
Medium impact
Medicaid Behavioral Health Providers In Nevada Get Raise To Help Children
Nevada Medicaid·Effective Jan 1, 2025
Nevada Medicaid increased reimbursement rates for children's behavioral health services by up to 25%, with 10% base increase, additional 10% for rural areas, and 5% more for home-based services. Changes are retroactive to January 1, 2025 and affect services like psychotherapy, basic skill training, and psychosocial rehabilitation for youth under 21.
Medium impact
Quarter 2 2026 New Code Update
Nevada Medicaid·Effective Apr 1, 2026
Nevada Medicaid is implementing new Quarter 2 2026 CPT, HCPCS, and ADA codes effective April 1, 2026. Claims with these new codes will initially suspend with error code 853 until rates and policies are updated in the system, and retroactive prior authorizations will be allowed during the transition period.
High impact
Attention Electronic Visit Verification (EVV) Providers: Updates Regarding EVV Claims Submissions
Nevada Medicaid·Effective Apr 1, 2026
Starting April 1, 2026, Electronic Visit Verification (EVV) claims for home health and personal care services will no longer route through Optum and must be submitted directly to payers using new payer IDs. Providers using alternate EVV systems must update their billing workflows with the new payer IDs, while Sandata users will have changes made automatically.
Medium impact
Attention Behavioral Health Providers: Update to Web Announcement 2858 Regarding Licensed Master Social Worker (LMSW) Post-Graduate Interns Enrolling as a Qualified Mental Health Professional (QMHP)
Nevada Medicaid·Effective Apr 1, 2026
Nevada Medicaid has updated enrollment requirements for Licensed Master Social Worker (LMSW) Post-Graduate Interns who want to enroll as Qualified Mental Health Professionals. The policy clarifies documentation requirements and mandates that interns who become Licensed Clinical Social Workers must update their enrollment to Independent Professional status.
High impact
Medicaid Services Manual Chapters Updated
Nevada Medicaid·Effective Feb 25, 2026
Nevada Medicaid updated six chapters of their Services Manual with significant changes to mental health services, physician services, prescribed drugs, substance use disorder treatment, peer support services, and intellectual disability facilities. Key changes include revised reimbursement structures, updated prior authorization requirements, and new provider enrollment requirements for multiple locations.
Low impact
Attention Provider Type 93 (Substance Use Treatment): Free CASAT Webinar on April 13, 2026
Nevada Medicaid·Effective Apr 13, 2026
Nevada Medicaid is offering a free CASAT webinar on April 13, 2026, specifically for Provider Type 93 (Substance Use Treatment) providers. The webinar covers ASAM 4th Edition Level of Care Assessment and Treatment Planning Assessment.
Medium impact
Technical Bulletin: Expanded April 2026 Administration Window for RSV Prevention in Nevada
Nevada Medicaid·Effective Apr 2, 2026
Nevada has extended the administration window for RSV prevention through April 30, 2026, allowing continued billing for infant RSV monoclonal antibodies (nirsevimab and clesrovimab) and maternal RSV vaccination (Abrysvo) during pregnancy beyond the typical March cutoff. This extension applies to Nevada Medicaid and affects billing eligibility for RSV preventive treatments.
Low impact
Transportation Support
Nevada Medicaid·Effective Jan 1, 2026
Nevada Medicaid has updated transportation support resources and contact information for members to schedule rides to medical appointments. Rural members now use health plans (CareSource or SilverSummit) for transportation scheduling instead of fee-for-service, while urban members continue using MTM.
Low impact
NOW OPEN: Apply for Nevada Rural Tribal Health Transformation Funding
Nevada Medicaid·Identified Jun 21, 2026
Nevada has opened applications for Rural Tribal Health Transformation funding to improve health outcomes for Nevada's Tribal Nations through strengthened health systems and improved care access. The first application deadline is May 29, 2026, with a potential second round if funds remain.
Medium impact
Drug Use Review (DUR) Board approves changes effective April 6, 2026
Nevada Medicaid·Effective Apr 6, 2026
Nevada Medicaid updated prior authorization criteria for multiple specialty drug classes including immunomodulators, respiratory biologics, hormone modifiers, hereditary angioedema agents, Duchenne muscular dystrophy agents, and created new criteria for neurokinin-3 receptor antagonists. These changes affect point-of-sale pharmacy criteria and require updated prior authorization forms.
Medium impact
Service Limitation for Procedure Code A4322
Nevada Medicaid·Effective Apr 7, 2026
Nevada Medicaid has clarified that procedure code A4322 is limited to 4 units per rolling month and requires prior authorization to exceed this limit. Claims exceeding 4 units without prior authorization will be denied with error code 5553.

Browse by payer Browse by state Browse by specialty Browse by billing code Browse & filter all changes

Get alerts for changes like this

Save a search and receive a daily digest whenever a new policy change matches your filters.

Create a free alert

Archive by year

2023 2024 2025 2026

Insurance Policy Changes Tracker: All Payer Updates (Page 74) | PolicyChanges.app

Attention Provider Type 60 (School Health Services): Ordering, Prescribing and Referring Requirements Updated

Medicaid Services Manual Chapter 4500 Updated

Attention All Providers: Top 10 Claim Denial Reasons and Resolutions/Workarounds for February 2026 Professional Claims

Attention Provider Types 24 (Advanced Practice Registered Nurse), 74 (Nurse Midwife), and 77 (Physician’s Assistant): Claims Have Been Reprocessed to Pay Updated Rates

Attention Provider Type (PT) 19 (Nursing Facilities) and Hospitals under PTs 10, 11, 13, and 14: Pre-Admission Screening and Resident Review (PASRR), Level of Care (LOC), and Nursing Facility Tracking (NFT) Requests Can Be Submitted Under One Profile

Attention All Providers: Medicaid ID Cards

New Specialties 033 (Mobile Crisis Team) and 034 (Intensive Crisis Stabilization Services) Under Provider Type 87 (Crisis Services) Are Available for Enrollment

Attention Provider Type 33 (Durable Medical Equipment, Prosthetics, Orthotics and Supplies): Authorization Criteria Updated to Remove Incorrect Requirements

Medicaid Management Information System Updated with NCCI Quarter 2 2026 Files

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

Form FA-13A Updated to Rehabilitative Residential Treatment Services Absence Form

Attention Federally Qualified Health Center (FQHC) Providers: Clarification of Pharmacist Codes Billable for Encounters

NOW OPEN: Apply for Nevada’s Rural Health System Flex Fund

Attention Provider Type 22 (Dentist): Veneers Are No Longer Covered for Adults and Pregnant Members

Medicaid Behavioral Health Providers In Nevada Get Raise To Help Children

Quarter 2 2026 New Code Update

Attention Electronic Visit Verification (EVV) Providers: Updates Regarding EVV Claims Submissions

Attention Behavioral Health Providers: Update to Web Announcement 2858 Regarding Licensed Master Social Worker (LMSW) Post-Graduate Interns Enrolling as a Qualified Mental Health Professional (QMHP)

Medicaid Services Manual Chapters Updated

Attention Provider Type 93 (Substance Use Treatment): Free CASAT Webinar on April 13, 2026

Technical Bulletin: Expanded April 2026 Administration Window for RSV Prevention in Nevada

Transportation Support

NOW OPEN: Apply for Nevada Rural Tribal Health Transformation Funding

Drug Use Review (DUR) Board approves changes effective April 6, 2026

Service Limitation for Procedure Code A4322