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Nevada MedicaidMedicaid · Prior Auth · Provider Enrollment · NV · Psychiatry, PediatricsHigh impact

Attention Provider Type 63 (Psychiatric Residential Treatment Facilities): Age Correction for Complex Case Criteria

Act
by Oct 1, 2026
Effective date
Oct 1, 2026
Identified
Oct 2, 2026

Summary

Nevada Medicaid corrects the age threshold for the special rate applicable to private psychiatric residential treatment facilities (PRTF) for complex cases. The special rate now applies only to children under 9 years old; children 9 years and older must meet complex case criteria defined in the updated FA-15 prior authorization form. This is a correction to Web Announcements 3970 and 3999.

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What to do

by Oct 1, 2026 · 6 steps
01Billing and prior authorization team must implement the corrected age threshold for PRTF complex case billing.
02Download and begin using the updated FA-15 prior authorization form effective 10/01/2026.
03Update billing system and prior auth workflows to apply the special PRTF complex case rate only to children less than 9 years old.
04For all PRTF admissions of children age 9 and older, require documentation of complex case criteria per the new FA-15 form before billing the complex case rate.
05Train staff to distinguish between age-based eligibility (under 9) versus criteria-based eligibility (age 9+).
06Review and update any internal guidelines or billing sheets that referenced the previous age criteria.
If missed: Failure to apply the correct age threshold will result in claim denials and potential overpayment recovery.

Original notice

Attention Provider Type 63 (Psychiatric Residential Treatment Facilities): Age Correction for Complex Case Criteria
medicaid.nv.gov · Always check the source before changing claims.
View original ↗

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Nevada Medicaid policiesNV policy changesPsychiatryPediatrics

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