MedicaidReimbursementHigh impact
Attention Behavioral Health Outpatient Providers and Provider Type 63 (Psychiatric Residential Treatment Facilities): Reprocessing Efforts
Nevada Medicaid·NV · Psychiatry·Provider Enrollment
Effective date
Jan 1, 2025
We identified it
Jul 28, 2026
Summary
Nevada Medicaid is reprocessing claims for behavioral health outpatient providers and psychiatric residential treatment facilities (Provider Type 63) retroactively to January 1, 2025, to apply approved rate increases for pediatric services. A second recycling period for outpatient behavioral health claims will occur shortly, and a single recycle for PRTF facilities will be completed automatically. This is a one-time exception allowing reimbursement at fee schedule rates regardless of usual and customary charges previously billed. Fee-For-Service claims only; MCOs have 60 days to implement rate changes prospectively.
Action Required
REQUIREMENTS:
- Immediately: Billing team must monitor for automated claim reprocessing activities from Nevada Medicaid for Behavioral Health Outpatient and PRTF claims submitted on or after January 1, 2025. No manual rebilling is required; recycled payments will be generated automatically.
- Before second recycling completion: Billing team should review any claim denials upon reprocessing, as all system and clinical claim editor edits will apply. Prepare to file appeals for any inappropriately denied claims using the Nevada Medicaid Services Manual and Nevada Medicaid Billing Manual appeal procedures and timeframes.
- Verify Fee-For-Service eligibility: Confirm this policy applies only to Fee-For-Service Medicaid claims. If your practice bills Nevada Medicaid MCOs, these retroactive adjustments do NOT apply; MCOs have up to 60 days from January 1, 2026, to implement rate changes on a go-forward basis only.
- Documentation: Ensure providers understand this is a one-time exception. Future rate increases will NOT include retroactive reprocessing exceptions, so compliance with usual and customary charge billing requirements (Medicaid Services Manual Section 105) must resume after this cycle.
- Reference Web Announcements 3860 (behavioral health outpatient rate increases) and 3970 (PRTF rate details) for specific procedure codes and rates affected.