MedicaidAdministrativeMedium impact
Attention All Providers: Issue Related to Claims with Prior Authorization (PA) to Exceed Service Limits Has Been Resolved
Nevada Medicaid·NV·Prior Authorization
Effective date
Dec 15, 2025
We identified it
Jun 21, 2026
Summary
Nevada Medicaid resolved a system issue where claims with prior authorization to exceed service limits were only paying for PA units instead of total allowed units. Effective December 15, 2025, the system will properly pay for all allowed units, and previously underpaid claims will be automatically reprocessed.
Action Required
Immediately: Monitor future remittance advice for automatically reprocessed claims that were previously underpaid due to PA service limit issues. Be aware that reprocessed claims may still face denials due to other system edits, and prepare to appeal denied claims if necessary using Medicaid Services Manual Chapter 100 guidelines.