MedicaidPrior AuthHigh impact
Attention Provider Type (PT) 93 (Substance Use Treatment): Substance Use Treatment/Outpatient Behavioral Health Authorization Request Form (FA-11D), Enrollment Checklists, and Billing Guidelines Updated
Nevada Medicaid·NV · Psychiatry·Prior Authorization
Effective date
Aug 1, 2026
We identified it
Aug 1, 2026
Summary
Nevada Medicaid updated the Substance Use Treatment/Outpatient Behavioral Health Authorization Request Form (FA-11D) and related enrollment checklists and billing guides to align with ASAM 4th Edition standards. Providers must discontinue use of the previous FA-11D version and transition to the updated form by August 1, 2026. Submissions using the old form will be pended through August 30, 2026, and denied on or after September 1, 2026.
Action Required
By July 31, 2026: Billing and clinical staff must obtain and review the updated FA-11D form from the Nevada Medicaid provider website and the updated billing guides for specialties 704, 707, and 708. By August 1, 2026: Update all prior authorization submission workflows and templates to use ONLY the new FA-11D form. Stop using the previous version immediately. Notify all providers, clinical staff, and authorizations personnel of the change. From August 1-30, 2026: If a previous FA-11D version is submitted, the PA will be pended and the provider will have 5 days to resubmit using the new form. On September 1, 2026: All PA requests must use the new FA-11D or they will be denied. Ensure billing software, submission systems, and internal processes reflect this requirement to prevent claim denials.