MedicaidAdministrativeMedium impact
Attention Provider Type 12 (Hospital, Outpatient): Observation Claims That Paid In Error Have Been Reprocessed
Nevada Medicaid·NV · Emergency Medicine, Internal Medicine, Family Medicine·Provider Enrollment
Effective date
Oct 15, 2025
We identified it
Jun 21, 2026
Summary
Nevada Medicaid has automatically reprocessed outpatient hospital observation claims that exceeded the 24-hour daily or 48-hour per encounter limits without proper authorization, affecting claims from September 2023 through September 2025. Reprocessed claims will show error codes 5611 or 5661 and results will appear on October 24 remittance advice.
Action Required
By October 24, 2025: Billing team must review remittance advice for reprocessed observation claims with error codes 5611 (24 Units Allowed Per Day) or 5661 (48 Hours Per Encounter-PA Override). For future observation claims using G0378 with revenue code 0762, ensure prior authorization is obtained before exceeding 24 hours per day or 48 hours per encounter limits. Claims exceeding these limits without authorization will be denied.