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Attention All Providers: Top Claim Denial Reasons and Resolutions/Workarounds for December 2025 Professional Claims
Nevada Medicaid·NV·Billing & Coding
Effective date
Jan 15, 2026
We identified it
Jun 21, 2026
Summary
Nevada Medicaid has identified the top 9 claim denial reasons for December 2025 professional claims and provided specific resolutions. This guidance helps billing teams understand common denial codes and their workarounds to reduce future claim rejections.
Action Required
Immediately: Billing team must review all pending Nevada Medicaid claims for the 9 common denial error codes (452, 3340, 4021, 1047, 1009, 5035, 4371, 4801, 2003). For each denial type, follow the specific resolution steps: verify Medicare crossover details for code 452, check fee schedules for coverage rules (codes 3340, 4021, 4801), confirm provider enrollment status for codes 1047 and 1009, review claim history for duplicates (code 5035), verify claim types for code 4371, and confirm patient eligibility for code 2003. Use the Provider Web Portal and referenced manuals for detailed instructions.