PAYER POLICY CHANGES

Nevada Medicaid Policy Changes

Policy changes from Nevada Medicaid and from Medicaid managed care plans in Nevada, with the Medicaid prior authorization lists and payer contacts we track for the state. Each item links to its public source.

Nevada Medicaid · Identified Nov 6, 2026Low impact
New Specialty 318 (Assertive Community Treatment) To Be Created Under Provider Type 14 (Behavioral Health Outpatient Treatment)
Nevada Medicaid is creating a new specialty 318 (Assertive Community Treatment, ACT) under provider type 14 (Behavioral Health Outpatient Treatment) for individuals with serious mental illness and/or co-occurring disorders. The specialty is still in development; providers must enroll with a unique NPI once it opens for enrollment through Provider Flex, and billing details will appear in an updated PT 14 Billing Guide.
Nevada Medicaid · Identified Nov 6, 2026Low impact
Nevada Medicaid Update to 340B Actual Acquisition Cost Billing Language
Nevada Medicaid updated its billing manual language for 340B Actual Acquisition Cost (AAC) so that AAC is defined as the net unit cost to the facility after deducting all rebates and discounts. Covered entities must still submit their 340B AAC to Nevada Medicaid, and written AAC protocols may not include an inflation markup, spread, or margin added to the actual purchase price after discounts. The payer states the update is intended to clarify the current billing process and does not represent a fundamental change.
Nevada Medicaid · Identified Nov 5, 2026Medium impact
Attention All Providers: Top Prior Authorization Denial Reasons for the Second Quarter of 2026
Historical material: Nevada Medicaid's July 31, 2026 web announcement (issued for the second quarter of 2026) lists the top reasons prior authorization requests were denied and suggested steps for providers. For the billing team, the practice should review the listed denial reasons (medical necessity documentation, pending PA requests in the Provider Web Portal, recipient eligibility on dates of service, PA submission timelines, and outdated request forms) and adjust its PA workflow accordingly. The announcement states no effective date or deadline.
Nevada Medicaid · Identified Nov 5, 2026Low impact
Attention Provider Type 19 (Nursing Facility Providers): Update Nursing Facility Quarterly Resident Roster Web Portal
Nevada Medicaid is moving quarterly resident roster distribution for freestanding nursing facilities (Provider Type 19) from existing channels to a secure web portal run with its contractor Myers and Stauffer, similar to the cost-reporting portal. Starting January 2027, the state will rely solely on the web portal for distributing these rosters, so facilities should identify staff needing access by emailing NVMDSRosters@MSLC.com.
Nevada Medicaid · Identified Nov 5, 2026Medium impact
Web Announcement 4053
Nevada Medicaid published Web Announcement 4053 listing the top prior authorization denial reasons for Q3 2026 (medical necessity, missing information, eligibility, untimely requests, outdated forms, illegible documentation, and late reconsiderations). Billing teams should use the listed suggested actions to tighten PA submissions: check eligibility in the Provider Web Portal, submit with current forms and complete clinical documentation, track pending PA notes, and meet the timely filing windows in the Billing Manual.
Nevada Medicaid · Effective Jan 1, 2025Medium impact
Attention Provider Type 20 (Physician, M.D., Osteopath, D.O) Specialty 170 (Maxillofacial Surgery) and Provider Type 22 (Dentist): Rate Updates for Procedure Codes D9222 and D9223
Nevada Medicaid updated reimbursement rates for anesthesia procedure codes D9222 and D9223 effective January 1, 2025. Members under age 6 receive an additional 15% of the current rate. The payer will automatically reprocess prior claims paid at incorrect rates; results will appear on future remittance advice. MCOs have up to 60 days after receiving updated rate files to implement changes on a go-forward basis starting January 1, 2026.
Nevada Medicaid · Effective Feb 1, 2027High impact
Attention Electronic Visit Verification (EVV) Providers: Claims That Do Not Match EVV Visit Data Will Deny Beginning February 1, 2027
Starting February 1, 2027, Nevada Medicaid will deny claims from home health, personal care services, and waiver providers that do not match verified visit data in electronic visit verification (EVV) systems. Currently these mismatches generate informational error codes only; the practice must ensure all claim details align with EVV system records to avoid future denials.
Nevada Medicaid · Effective Nov 2, 2026Medium impact
Drug Utilization Review (DUR) Board approves changes effective November 2, 2026
Nevada Medicaid updated pharmacy point-of-sale (POS) prior authorization criteria effective November 2, 2026, for nine drug classes including ADHD agents, respiratory biologics, antibiotics, and rare disease therapies. The practice must obtain updated prior authorization forms and apply new clinical criteria when billing these medications for Nevada Medicaid members.
Nevada Medicaid · Effective Nov 1, 2026High impact
Silver State Scripts Board Made Changes to the Preferred Drug List Effective November 1, 2026
Silver State Scripts Board changed Nevada Medicaid's Preferred Drug List effective November 1, 2026, moving multiple drugs between preferred and non-preferred status, adding prior authorization requirements to some agents, and removing discontinued products. The billing team must track which drugs patients are prescribed, obtain prior authorizations where newly required, and expect claim denials for non-preferred drugs or discontinued products without prior auth or member exception requests.
Nevada Medicaid · Effective Dec 31, 2025Medium impact
Respiratory Syncytial Virus (RSV) Prevention for the 2026–2027 Season
Synagis (palivizumab) was discontinued by the manufacturer effective December 31, 2025, and is no longer available. Nevada Medicaid now expects providers to use currently recommended RSV prevention options—specifically Beyfortus (nirsevimab) for infants entering their first RSV season and high-risk children entering their second season, or Enflonsia (clesrovimab) for eligible infants entering their first season—following current AAP guidance and FDA labeling.
Nevada Medicaid · Effective Oct 19, 2026Low impact
Treatment History Search Function Expanded to Include Hospice and Peer Support Service Provider Types
Nevada Medicaid expanded the Treatment History search function in the Provider Web Portal to include Hospice (PT 64, PT 65) and Peer Support Services (PT 97) providers effective October 19, 2026. These provider types and their delegates can now access recipient treatment and claim history through the portal.
Nevada Medicaid · Effective Jul 1, 2026High impact
Nevada Private Hospital Assessment State Fiscal Year (SFY) 2027 Rate Levied
Nevada private hospitals are subject to a new state assessment for State Fiscal Year 2027, effective July 1, 2026. The assessment rates are 1.97079% (Q1) and 1.73728% (Q2-Q4) for inpatient services, and 1.71567% (Q1) and 1.51239% (Q2-Q4) for outpatient services, applied to net patient revenue less Medicare revenue. The Nevada Health Authority will issue invoices in the coming weeks specifying exact amounts owed.
Nevada Medicaid · Effective Oct 27, 2026Medium impact
Quarter 4 2026 New Code Update
Nevada Medicaid has added rates for Quarter 4 2026 new CPT, HCPCS, and ADA codes to its billing system. Effective October 27, 2026, claims with these new codes will process without suspension. Previously suspended claims (with error code 853) dating to October 1, 2026, will be reprocessed; providers should expect potential denials and should review results on future remittance advice.
Nevada Medicaid · Effective Oct 26, 2026High impact
Attention Provider Type 17 (Special Clinics) Specialty 181 (Federally Qualified Health Centers): Procedure Code T1015 Closed for Billing
Nevada Medicaid has closed procedure code T1015 (Clinic Visit/Encounter, All-Inclusive) for billing by Provider Type 17 (Special Clinics) specialty 181 (Federally Qualified Health Centers) effective October 26, 2026. This is a go-forward change; no claims will be automatically reprocessed.
Nevada Medicaid · Effective Oct 13, 2026Medium impact
ICD-10 Diagnosis Code Will Be Required on Gender Affirming Care Medications for Children beginning October 13, 2026
Effective October 13, 2026, Nevada Medicaid requires an ICD-10 diagnosis code at point-of-sale for gender affirming care medications dispensed to pediatric patients, following a CMS Final Rule. Nevada Medicaid will continue funding these medications with state funds; the diagnosis code requirement is a new billing mandate to properly capture and process these claims.
Nevada Medicaid · Identified Oct 24, 2026Low impact
Attention All Providers, Delegates and Staff: Upcoming Training Sessions for November 2026
Nevada Medicaid is offering optional provider training sessions throughout November 2026 covering topics such as secondary claims submission, therapy office hours, enrollment overviews for various provider groups, dental and behavioral health workshops, and billing procedures for specialized facilities. This is an informational announcement about voluntary training opportunities with no billing workflow changes or policy modifications.
Nevada Medicaid · Identified Oct 23, 2026Medium impact
Attention Provider Type 22 (Dentist) Specialty 079 (Orthodontia): Extension of Reconsideration Timeframe for Orthodontia Prior Authorization Requests
Nevada Medicaid has extended the reconsideration timeframe for orthodontia prior authorization requests from 30 calendar days to 90 calendar days from the date of original determination. Providers must submit reconsideration requests using form FA-29B via the Provider Web Portal with additional medical justification supporting the level of care requested.
Nevada Medicaid · Identified Oct 22, 2026Medium impact
Attention Provider Type 32 Specialty 249 (Community Paramedicine): Prior Authorization and Service Limitations
Nevada Medicaid clarifies that Community Paramedicine (Provider Type 32, Specialty 249) services do not require initial prior authorization under Fee-for-Service. However, certain covered codes have service limitations that may be overridden by submitting a prior authorization request when additional services are medically necessary. Billing teams should consult the PT 32 Specialty 249 Billing Guide for specific codes and service limits.
Nevada Medicaid · Effective Jul 1, 2026Medium impact
New Specialty 715 (Community Residential Mental Health Services (CRMHS)) Under Provider Type 63 (Rehabilitative Residential Treatment Services) Available for Enrollment
Nevada Medicaid has opened enrollment for a new Specialty 715 (Community Residential Mental Health Services under Provider Type 63) effective July 1, 2026. Eligible providers may backdate enrollment to that date using the Provider Flex tool and must obtain a unique NPI. This is classified as high-risk and requires fingerprint-based criminal background checks and site visits as conditions of participation.
Nevada Medicaid · Effective Jul 21, 2026High impact
Attention Personal Care Services (PCS) Providers: Reminder to Use Updated Prior Authorization Form FA-24
Nevada Medicaid updated the Personal Care Services (PCS) Prior Authorization form FA-24 effective July 21, 2026. Providers must immediately discontinue use of previous form versions and use only the updated FA-24 dated 07/21/2026 for all PCS visit types, initial PA submissions, and provider transfers. Requests submitted with previous versions will not be accepted.
Nevada Medicaid · Identified Oct 20, 2026Medium impact
Medicaid Services Manual Chapters Updated
Nevada Medicaid updated three Medicaid Services Manual chapters effective September 30–October 5, 2026. Changes include: (1) new licensure requirement for nursing facility administrators; expansion of Behaviorally Complex Care Program with a 3.0% quality incentive payment; (2) pharmacy lock-in period reduced from 36 to 24 months, updated diabetic supply and topical scabicide criteria; and (3) updated references and organizational names for certified community behavioral health centers. All updates are already effective as of the analysis date.
Nevada Medicaid · Effective Sep 30, 2026Medium impact
Medicaid Operations Manual Chapter 1100 Updated
Nevada Medicaid updated MOM Chapter 1100 (Long Term Provider Tax) effective September 30, 2026. The revision changes the frequency of tax processing from annual/yearly to quarterly/by-quarter in Sections 1103 and 1104. Providers billing Nevada Medicaid must verify current compliance with the new quarterly processing schedule.
Nevada Medicaid · Identified Oct 20, 2026Medium impact
Attention Provider Type 63 (Rehabilitative Residential Treatment Services): Updates to Enrollment Requirements
Nevada Medicaid updated enrollment requirements for Provider Type 63 (Rehabilitative Residential Treatment Services). Medical/Clinical Director licenses must now be uploaded to the Medical/Clinical Director section of the application rather than Miscellaneous Attachments, and the Provider Flex Enrollment tool now requires individual providers (PT 14, 20, 24, 26, 85) to link to a PT 63 group, with OPR specialty 400 providers excluded from group linking.
Nevada Medicaid · Effective Oct 19, 2026High impact
Attention Provider Type 63 (Rehabilitative Residential Treatment Services): New Shadow Billing Requirements
Nevada Medicaid has implemented new shadow billing requirements for Provider Type 63 (Psychiatric Residential Treatment Facilities) effective October 19, 2026. Providers must use encounter revenue code 0911 with qualified CPT codes as shadow procedure codes alongside Room & Board codes, though enforcement is deferred until 2027. A supplemental document listing approved shadow billing codes will be posted to the Billing Information webpage.
Nevada Medicaid · Identified Oct 15, 2026Medium impact
Attention All Providers: Top 10 Claim Denial Reasons and Resolutions/Workarounds for August 2026 Professional Claims
Nevada Medicaid published a retrospective analysis of the top 10 claim denial reasons for August 2026 professional claims, identifying specific error codes, EOB codes, and resolutions. This is informational guidance documenting historical denial patterns and troubleshooting steps; it does not announce new policy changes or effective dates affecting future billing.
Nevada Medicaid · Effective Oct 14, 2026Medium impact
Attention Behavioral Health Providers: Prior Authorization Forms FA-11, FA-11B, FA-11D, FA-11E, FA-12, and FA-14 Have Been Updated
Nevada Medicaid has updated six behavioral health prior authorization forms (FA-11, FA-11B, FA-11D, FA-11E, FA-12, FA-14) effective 10/14/2026. Each form now includes a new question asking whether the request is for Healthy Kids (EPSDT) services. Providers must immediately discontinue use of previous form versions and switch to the updated versions dated 10/14/2026.
Nevada Medicaid · Identified Oct 15, 2026Medium impact
Web Announcement 4031
Nevada Medicaid published a retrospective analysis of the top 10 claim denial reasons for September 2026 professional claims, with corresponding error codes, EOB codes, and resolution guidance. This is informational documentation of historical denial patterns and troubleshooting steps, not a policy change with a future effective date. The billing team should use this as a reference to audit current claim denials and verify compliance with existing Nevada Medicaid billing requirements.
Nevada Medicaid · Effective Oct 12, 2026High impact
Error Code 769 Updated for Telehealth Originating and Distant Site
Nevada Medicaid is enforcing error code 769 to deny telehealth claims where a single provider bills as both the originating site and distant site for the same patient on the same date of service. This policy change became effective October 12, 2026, and claims will not be automatically reprocessed; providers must ensure compliance going forward.
Nevada Medicaid · Effective Jan 1, 2027High impact
Attention Provider Types 17 (Special Clinics) Specialty 181 (Federally Qualified Health Center) and 47 (Tribal Health Clinics): End-Date of CDT D1999, Tentatively Effective January 1, 2027
Nevada Medicaid will end-date CDT code D1999 (used for diabetic dental services under the 1115 Whole Mouth Whole Body Dental Demonstration Waiver) effective January 1, 2027. Starting that date, Tribal Health Clinics (PT 47) will bill covered dental services under the T1015 encounter rate, while Federally Qualified Health Centers (PT 17 Specialty 181) will bill using D2999 and applicable shadow billing codes.
Nevada Medicaid · Identified Oct 13, 2026Medium impact
Clarification on Billing Modifiers TC and 26 with Global Procedure Codes
Nevada Medicaid clarified billing rules for CPT codes with modifiers TC (technical component) and 26 (professional component) on global procedure codes. Providers must bill the unmodified global code only when both components are performed by the same provider; when components are split between providers, only the performing provider bills with the appropriate modifier. Both modifiers cannot be billed by the same provider for the same recipient and date of service.
Nevada Medicaid · Identified Oct 13, 2026Low impact
No Action Needed: Okta Email Change Notice Sent in Error
Nevada Medicaid sent an erroneous automated notification to some providers stating their email addresses had been changed. This was a system error during maintenance; no actual changes to provider account, sign-in, or email information occurred. No action is required from providers or billing staff.
Nevada Medicaid · Identified Oct 10, 2026Medium impact
New Specialty 715 (Community Residential Mental Health Services (CRMHS)) To Be Created Under Provider Type 63 (Rehabilitative Residential Treatment Services)
Nevada Medicaid is creating a new Specialty 715 (Community Residential Mental Health Services/CRMHS) under Provider Type 63 for short-term residential mental health treatment in group home settings with up to 16 beds. Eligible providers may backdate enrollment to July 1, 2026, and must complete fingerprint-based criminal background checks and site visits. Billing will use Professional claim form (837P) with shadow billing required.
Nevada Medicaid · Effective Oct 5, 2026Medium impact
Update on Claims for Long-Acting Reversible Contraception (LARC) Devices
Nevada Medicaid has updated its system to eliminate inappropriate denials (error code 5051) when inpatient and outpatient claims for long-acting reversible contraception (LARC) devices are billed concurrently by eligible provider types. Previously denied claims with dates of service on or after March 31, 2025 will be automatically reprocessed; billing teams should monitor for reprocessed claims and potential alternative denials.
Nevada Medicaid · Identified Oct 3, 2026Medium impact
Attention All Providers of Maternity Services: Nevada Medicaid and Unbundling Maternity Care Services Codes
Nevada Medicaid will NOT adopt the AMA's new unbundled maternity care coding structure on January 1, 2027. Providers must continue using the current bundled maternity code structure. Nevada Medicaid is developing a future reimbursement model with details expected mid-2027.
Nevada Medicaid · Effective Jan 1, 2025High impact
Attention Provider Type 63 (Psychiatric Residential Treatment Facility (PRTF)): Rate Reform Implemented for Private PRTFs (Updated October 1, 2026)
Nevada Medicaid implements new reimbursement rates for private Psychiatric Residential Treatment Facilities (PRTF, Provider Type 63) effective January 1, 2025, establishing a flat rate of $800 for revenue codes 100 and 183, with an optional $150 add-on (max $950) for children under 9 or with complex needs requiring prior authorization using new revenue code 120 and Form FA-15 starting August 1, 2026.
Nevada Medicaid · Effective Aug 1, 2026High impact
Attention Provider Type 63 (Psychiatric Residential Treatment Facilities): Guidance for Requesting Complex Case Criteria (Updated October 1, 2026)
Nevada Medicaid has introduced a new revenue code 0120 for complex case rates at psychiatric residential treatment facilities (PRTF) for children under 9 or those meeting complex case criteria, effective August 1, 2026. Providers must use Form FA-15 to request this rate and cannot submit revenue codes 0100 and 0120 simultaneously. If the wrong code was initially submitted, providers must file a data correction (Form FA-29) within 5 business days.
Nevada Medicaid · Effective Oct 1, 2026High impact
Attention Provider Type 63 (Psychiatric Residential Treatment Facilities): Age Correction for Complex Case Criteria
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.
Nevada Medicaid · Identified Oct 1, 2026Medium impact
Attention Provider Type 63 (Rehabilitative Residential Treatment Services) Specialty 963 (Psychiatric Residential Treatment Facility): Complete a Cost Report By November 20, 2026
Nevada Medicaid requires all Psychiatric Residential Treatment Facilities (Provider Type 63, Specialty 963) to complete and submit a cost report by November 20, 2026. This is a new annual requirement that will support rate-setting, quality incentive development, and access-to-care initiatives under the PRTF State Plan Amendment process.
Nevada Medicaid · Identified Oct 1, 2026Medium impact
Attention Hospital and NICU Providers: Billing Guidance for Deemed Newborns, Including Infants in the Custody of Licensed Private Child-Placing Agencies
Nevada Medicaid clarifies that newborns born to Medicaid-eligible mothers retain deemed Medicaid eligibility from birth through their first birthday even if custody or placement changes (including placement with licensed private child-placing agencies, foster families, or prospective adoptive parents). Billing teams should use the mother's Medicaid ID until the infant receives a separate ID, then verify eligibility and MCO enrollment in the Provider Web Portal before billing.
Nevada Medicaid · Effective Jan 1, 2027High impact
New Community Work Requirements for Certain Individuals
Starting January 1, 2027, Nevada Medicaid is implementing new community work requirements for adults ages 19-64, requiring 80 hours of work, school, or volunteering per month to maintain eligibility. Additionally, redetermination cycles are changing from annual to semi-annual for affected members. Billing teams must prepare to verify member eligibility and redetermination dates, as non-compliance with work requirements will affect coverage.
Nevada Medicaid · Identified Sep 30, 2026High impact
Attention All Providers: Nevada Medicaid Issues Guidance Regarding Prior Authorization with Managed Care Organizations
Nevada Medicaid issued clarifying guidance on prior authorization requirements for MCO (managed care organization) plans, effective immediately. MCOs can implement different prior auth requirements than FFS as long as clinical criteria are not more restrictive, but specific services (emergency, family planning, FQHC/RHC, mental health assessments, preventive care with USPSTF A/B grades, and others) are exempt from prior auth requirements. Standard prior auth responses must be issued within 2 business days; expedited requests within 72 hours.
Nevada Medicaid · Identified Sep 29, 2026Medium impact
Attention All Providers: Required Information Related to Provider Web Portal (PWP) Administrative Account Reset Requests (Updated August 27, 2026)
Nevada Medicaid has updated its Provider Web Portal (PWP) administrative account reset process. Providers must now submit specific required information to Gainwell Technologies when an administrator is unknown, has left the company, or no longer controls the account. Self-service password and user ID recovery options are available first.
Nevada Medicaid · Identified Sep 29, 2026High impact
Attention All Providers: Top Prior Authorization Denial Reasons for the First Quarter of 2026
Nevada Medicaid released its first-quarter 2026 prior authorization denial analysis identifying seven top reasons for PA rejections: medical necessity gaps, missing requested information, eligibility issues, late submissions, invalid forms, missed reconsideration deadlines, illegible documentation, and hospice-specific requirements. Billing teams must implement preventive measures across all PA workflows to reduce denials.
Nevada Medicaid · Identified Sep 29, 2026High impact
Attention All Providers: Top 10 Claim Denial Reasons and Resolutions/Workarounds for April 2026 Professional Claims
Nevada Medicaid released an urgent analysis of the top 10 claim denial reasons for April 2026 professional claims. The most common denials involve provider enrollment/contract issues (error codes 1047, 1076, 1009, 1048, 1852, 1854), non-covered services (3340), client ineligibility (2003), Medicare crossover coordination issues (452), and incorrect NPI grouping (1008). Billing teams must immediately implement verification procedures to prevent these denials.
Nevada Medicaid · Identified Sep 29, 2026Low impact
Attention All Providers, Delegates and Staff: Upcoming Training Sessions for July 2026 (Updated June 25, 2026)
Nevada Medicaid is announcing optional provider training sessions scheduled for July 2026 covering therapy, secondary claims submission, enrollment, new provider orientation, and dental services. This is an informational announcement with no billing policy changes, coverage modifications, or coding updates.
Nevada Medicaid · Effective Jul 1, 2026High impact
Attention Provider Type 22 (Dental): Expanded Coverage for Adults 21 Years and Older (Updated July 2, 2026)
Effective July 1, 2026, Nevada Medicaid (Provider Type 22 - Dental) expanded coverage for adults 21+ to include diagnostic, preventative, periodontal, and operative services (fillings and crowns). All expanded services are now subject to a $1,000 per calendar year limit, with new error code 5751 applied to claims exceeding this threshold. Emergency and palliative care remain unlimited.
Nevada Medicaid · Identified Sep 29, 2026High impact
Attention All Providers: Top 10 Claim Denial Reasons and Resolutions/Workarounds for June 2026 Professional Claims
Nevada Medicaid released an urgent analysis of the top 10 claim denial reasons for June 2026 professional claims, with specific error codes, EOB codes, and detailed resolutions. The billing team must immediately review and implement corrective actions for provider enrollment/contract issues, rendering provider linkage, claim modifiers, and third-party liability details to prevent ongoing denials.
Nevada Medicaid · Effective Jul 28, 2026High impact
Attention Provider Type 63 (Psychiatric Residential Treatment Services): Updated Enrollment Requirements (Updated July 28, 2026)
Nevada Medicaid has reclassified Psychiatric Residential Treatment Facilities (Provider Type 63) as high-risk providers, effective immediately. PT 63 providers must now complete fingerprint-based background checks, provide medical director licensure documentation, revalidate every 3 years instead of 5 years, and complete swift revalidation by October 31, 2026 or face enrollment suspension.
Nevada Medicaid · Identified Sep 29, 2026High impact
Attention All Providers: Top Claim Denial Reasons and Resolutions/Workarounds for July 2026 Professional Claims
Nevada Medicaid released urgent guidance on the top 10 claim denial reasons for July 2026, identifying common enrollment, linkage, and contract validation errors affecting professional claims. Billing teams must immediately audit claims for provider contract status, NPI linkage, group/individual provider matching, and duplicate submissions to prevent future denials. This is a fresh policy (1 day old) requiring immediate action to address systemic denial patterns.
Nevada Medicaid · Identified Sep 29, 2026Medium impact
RESOLVED: Attention PASRR Users: PASRR Portal Email Notification Issue (Updated September 22, 2026)
Nevada Medicaid's PASRR (Pre-Admission Screening Resident Review) Portal is experiencing a technical issue that prevents email notifications from being sent when screening statuses are updated. Providers can still manually log into the PASRR Portal to check screening status, but should not rely on email alerts during this outage.

Get alerts for changes like this

Save a search and get email alerts when a new policy change matches your filters: daily or weekly, your choice, on every plan.

Create a free alert How Policy Monitoring works

New Specialty 318 (Assertive Community Treatment) To Be Created Under Provider Type 14 (Behavioral Health Outpatient Treatment)

Nevada Medicaid Update to 340B Actual Acquisition Cost Billing Language

Attention All Providers: Top Prior Authorization Denial Reasons for the Second Quarter of 2026

Attention Provider Type 19 (Nursing Facility Providers): Update Nursing Facility Quarterly Resident Roster Web Portal

Web Announcement 4053

Attention Provider Type 20 (Physician, M.D., Osteopath, D.O) Specialty 170 (Maxillofacial Surgery) and Provider Type 22 (Dentist): Rate Updates for Procedure Codes D9222 and D9223

Attention Electronic Visit Verification (EVV) Providers: Claims That Do Not Match EVV Visit Data Will Deny Beginning February 1, 2027

Drug Utilization Review (DUR) Board approves changes effective November 2, 2026

Silver State Scripts Board Made Changes to the Preferred Drug List Effective November 1, 2026

Respiratory Syncytial Virus (RSV) Prevention for the 2026–2027 Season

Treatment History Search Function Expanded to Include Hospice and Peer Support Service Provider Types

Nevada Private Hospital Assessment State Fiscal Year (SFY) 2027 Rate Levied

Quarter 4 2026 New Code Update

Attention Provider Type 17 (Special Clinics) Specialty 181 (Federally Qualified Health Centers): Procedure Code T1015 Closed for Billing

ICD-10 Diagnosis Code Will Be Required on Gender Affirming Care Medications for Children beginning October 13, 2026

Attention All Providers, Delegates and Staff: Upcoming Training Sessions for November 2026

Attention Provider Type 22 (Dentist) Specialty 079 (Orthodontia): Extension of Reconsideration Timeframe for Orthodontia Prior Authorization Requests

Attention Provider Type 32 Specialty 249 (Community Paramedicine): Prior Authorization and Service Limitations

New Specialty 715 (Community Residential Mental Health Services (CRMHS)) Under Provider Type 63 (Rehabilitative Residential Treatment Services) Available for Enrollment

Attention Personal Care Services (PCS) Providers: Reminder to Use Updated Prior Authorization Form FA-24

Medicaid Services Manual Chapters Updated

Medicaid Operations Manual Chapter 1100 Updated

Attention Provider Type 63 (Rehabilitative Residential Treatment Services): Updates to Enrollment Requirements

Attention Provider Type 63 (Rehabilitative Residential Treatment Services): New Shadow Billing Requirements

Attention All Providers: Top 10 Claim Denial Reasons and Resolutions/Workarounds for August 2026 Professional Claims

Attention Behavioral Health Providers: Prior Authorization Forms FA-11, FA-11B, FA-11D, FA-11E, FA-12, and FA-14 Have Been Updated

Web Announcement 4031

Error Code 769 Updated for Telehealth Originating and Distant Site

Attention Provider Types 17 (Special Clinics) Specialty 181 (Federally Qualified Health Center) and 47 (Tribal Health Clinics): End-Date of CDT D1999, Tentatively Effective January 1, 2027

Clarification on Billing Modifiers TC and 26 with Global Procedure Codes

No Action Needed: Okta Email Change Notice Sent in Error

New Specialty 715 (Community Residential Mental Health Services (CRMHS)) To Be Created Under Provider Type 63 (Rehabilitative Residential Treatment Services)

Update on Claims for Long-Acting Reversible Contraception (LARC) Devices

Attention All Providers of Maternity Services: Nevada Medicaid and Unbundling Maternity Care Services Codes

Attention Provider Type 63 (Psychiatric Residential Treatment Facility (PRTF)): Rate Reform Implemented for Private PRTFs (Updated October 1, 2026)

Attention Provider Type 63 (Psychiatric Residential Treatment Facilities): Guidance for Requesting Complex Case Criteria (Updated October 1, 2026)

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

Attention Provider Type 63 (Rehabilitative Residential Treatment Services) Specialty 963 (Psychiatric Residential Treatment Facility): Complete a Cost Report By November 20, 2026

Attention Hospital and NICU Providers: Billing Guidance for Deemed Newborns, Including Infants in the Custody of Licensed Private Child-Placing Agencies

New Community Work Requirements for Certain Individuals

Attention All Providers: Nevada Medicaid Issues Guidance Regarding Prior Authorization with Managed Care Organizations

Attention All Providers: Required Information Related to Provider Web Portal (PWP) Administrative Account Reset Requests (Updated August 27, 2026)

Attention All Providers: Top Prior Authorization Denial Reasons for the First Quarter of 2026

Attention All Providers: Top 10 Claim Denial Reasons and Resolutions/Workarounds for April 2026 Professional Claims

Attention All Providers, Delegates and Staff: Upcoming Training Sessions for July 2026 (Updated June 25, 2026)

Attention Provider Type 22 (Dental): Expanded Coverage for Adults 21 Years and Older (Updated July 2, 2026)

Attention All Providers: Top 10 Claim Denial Reasons and Resolutions/Workarounds for June 2026 Professional Claims

Attention Provider Type 63 (Psychiatric Residential Treatment Services): Updated Enrollment Requirements (Updated July 28, 2026)

Attention All Providers: Top Claim Denial Reasons and Resolutions/Workarounds for July 2026 Professional Claims

RESOLVED: Attention PASRR Users: PASRR Portal Email Notification Issue (Updated September 22, 2026)