MedicaidPrior AuthHigh impact
Update to FA-11 Behavioral Health Outpatient or Rehabilitative Authorization Request Form
Nevada Medicaid·NV · Psychiatry·Prior Authorization
Effective date
May 8, 2026
We identified it
Jun 21, 2026
Summary
Nevada Medicaid has updated the FA-11 Behavioral Health Outpatient or Rehabilitative Authorization Request Form, adding new sections for Peer Support Services and changing attestation requirements. Starting May 8, 2026, all prior authorization requests must use the new form dated 04/09/2026 or they will be returned.
Action Required
By May 8, 2026: Billing and prior authorization staff must download and begin using only the updated FA-11 form dated 04/09/2026 from the Nevada Medicaid Provider Portal Forms webpage. Discontinue use of all previous versions immediately. Update prior authorization workflows to include new Peer Support Specialist sections when applicable. Forms submitted on old versions will be returned and require resubmission.