MedicaidAdministrativeMedium impact
Physician-Administered Drug (PAD) Claims That Denied With Error Code 5056 Will be Reprocessed
Nevada Medicaid·NV·Pharmacy
Effective date
Aug 25, 2025
We identified it
Jun 21, 2026
Summary
Nevada Medicaid has fixed a system error that was incorrectly denying physician-administered drug (PAD) claims with specific modifiers (KO, KP, KQ, JZ) using error code 5056. Claims processed since July 29, 2024 with these modifiers will be automatically reprocessed for potential payment.
Action Required
No immediate action required. Monitor future remittance advice for automatically reprocessed PAD claims that previously denied with error code 5056. Be aware that reprocessed claims may still deny for other reasons and can be appealed following standard procedures in Medicaid Services Manual Chapter 100.