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Attention All Providers: Top 10 Claim Denial Reasons and Resolutions/Workarounds for May 2024 Professional Claims
Nevada Medicaid·NV·Billing & Coding
Effective date
Jun 28, 2024
We identified it
Jun 21, 2026
Summary
Nevada Medicaid has published the top 10 claim denial reasons from May 2024 with specific resolution steps. This provides billing teams with actionable guidance to prevent common denial issues including prior authorization problems, eligibility verification errors, and coverage rule violations.
Action Required
Immediately: Billing team should review all 10 denial reasons and implement verification processes including: verify prior authorization numbers and dates before claim submission, check patient eligibility using EVS or calling (877) 638-3472, confirm CLIA license numbers are current in EVS, verify NDC codes with Pharmacy Benefits Manager at (800) 695-5526, and check fee schedules at dhcfp.nv.gov for covered codes. Update denial resolution workflows to follow the specific steps outlined for each error code.