MedStats Billing delivers end-to-end revenue cycle management built for Nevada practices. We work the new AB 52 deadlines — 21 calendar days to approve or deny an electronic claim and payment inside the same window — pursue the statutory interest that follows, challenge duplicate documentation requests, and bill all five Medicaid MCOs now operating statewide.
Two things changed in Nevada at once, and most practices are still billing as if neither happened. Assembly Bill 52, passed in the 2025 session, rewrote the claim payment deadlines: an electronic claim must now be approved or denied in 21 calendar days, and an approved claim must be paid inside that same window rather than 30 days after approval. And on 1 January 2026 Medicaid managed care went statewide across all 17 counties with a fifth plan entering the market, moving roughly 75,000 rural members out of fee-for-service. Nevada in 2026 is a different billing state than it was in 2025.
Nevada Billing Specializations:
AB 52 Processing Deadlines (2025) — Insurers and third-party administrators have 21 calendar days to approve or deny a claim submitted electronically and 30 calendar days for a claim submitted by mail or other non-electronic means, and an approved claim must be paid within that same 21 or 30-day period measured from receipt of the claim.
Statutory Interest — Where a claim is not paid inside the statutory timeframe, interest accrues from the payment due date until the claim is paid. Under the long-standing formula in NRS 683A.0879 and its companion sections, that rate is the prime rate at the largest bank in Nevada, as ascertained by the Commissioner of Financial Institutions on the preceding 1 January or 1 July, plus 6 percent.
The 20-Working-Day Information Request — A payer must request any additional information it needs within 20 working days of receiving the claim, and must then reprocess and pay within 21 days for an electronic claim or 30 days for a paper one. A late request does not buy the payer a new clock.
Limits on Duplicate Requests — Payers may not ask a provider to resubmit documentation already supplied unless there is a legitimate reason, and may not use repeat requests to delay payment. That single provision resolves the most common stall tactic in the state.
Denial Standards & Notice Content — A claim may not be denied without a reasonable basis. The denial notice must issue within 21 or 30 calendar days after receipt of all required information and must state the reason clearly, identify the criteria relied on and how they were applied, and explain how to appeal.
Provider Challenge Rights — Carriers must maintain a formal process for providers to challenge denied claims and must give participating providers annual notice of claims payment procedures under NRS 687B.730. A Provider Resource Program supports small and newly established practices working those rules.
Enforcement & Annual Reporting — The Division of Insurance may impose administrative penalties for violations, including failure to approve or deny a claim within 60 working days, and may suspend or revoke a certificate for repeat non-compliance. Insurers and TPAs file annual compliance reports beginning 1 February 2027 for calendar year 2026.
Statewide Medicaid Managed Care (from 1 January 2026) — Five MCOs now operate across all 17 counties: Health Plan of Nevada, Anthem Blue Cross and Blue Shield Healthcare Solutions, SilverSummit Healthplan, Molina Healthcare of Nevada and CareSource. Roughly 75,000 rural members moved from fee-for-service into managed care, and LIBERTY Dental Plan of Nevada remains the dental benefits administrator.
Redistribution & Plan Verification — Health Plan of Nevada stopped offering managed care in Washoe County from 1 January 2026 and its members were redistributed, while Clark County membership was rebalanced for the new entrant. Plan assignment on file from 2025 cannot be trusted, so eligibility is verified before every visit.
Workers’ Compensation & Auto — Work injury care is priced from the medical fee schedule the Division of Industrial Relations updates annually, with bills due within 90 days of service and the insurer required to pay or deny within 30 days of receipt. Nevada is an at-fault auto state with no PIP mandate and no auto medical fee schedule, so auto injury care runs on medical payments coverage, health coverage or liability recovery.
Major Nevada Payers — Anthem Blue Cross and Blue Shield of Nevada, Health Plan of Nevada, Hometown Health, Sierra Health and Life, Aetna, Cigna and the five Medicaid MCOs.
Built to bring clarity, control and consistency to your Nevada practice’s revenue cycle.
MedStats Billing manages the complete revenue cycle for Nevada providers — from Nevada Medicaid enrollment and MCO credentialing, through coding, claim scrubbing and submission, to denial challenges under the new notice standards, interest recovery, Division of Insurance complaints and workers’ compensation billing.
Certified CPT, ICD-10-CM, and HCPCS coding with pre-submission claim scrubbing built around each payer's edits, so claims pay on the first pass. We manage charge entry, claim submission, payment posting, and insurance follow-up.
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Enrollment with Medicaid managed care plans, Medicare via PECOS, and commercial payers — plus CAQH maintenance and re-credentialing deadline tracking, so your providers stay in-network and billable without gaps.
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Coverage confirmed before the visit — active policy status, deductibles, co-pays, plan type, and prior authorization requirements — so front-end denials are caught while there is still time to fix them.
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Aged claims worked by payer and denial reason, with appeals filed inside each plan's window. We monitor outstanding balances, manage rejections, and drive down days in A/R to protect cash flow.
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A detailed review of coding accuracy, documentation standards, and denial patterns that identifies revenue leakage and compliance exposure — before a payer audit finds it for you.
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Explore serviceNevada practices are losing money to a rulebook that changed under them in 2026, on both the commercial and the Medicaid side. These are the four we eliminate:
Nevada used to give payers 30 days to approve a claim and another 30 to pay it. Under AB 52 an electronic claim must be approved or denied in 21 calendar days and paid inside that same period. Practices still following up on the old schedule are chasing claims weeks after interest began to run.
Interest accrues from the payment due date until payment, at the prime rate of the largest bank in Nevada on the preceding 1 January or 1 July plus 6 percent. Practices rarely compute it, and a payer has no reason to volunteer money nobody has calculated.
AB 52 bars payers from requesting resubmission of documentation already provided unless there is a legitimate reason, and bars using such requests to delay payment. Practices that simply comply with the second and third request hand the payer the delay the statute now prohibits.
Managed care went statewide on 1 January 2026, a fifth MCO entered, Health Plan of Nevada left Washoe County managed care, and roughly 75,000 rural members moved out of fee-for-service. Any plan on file from last year may be wrong, and a claim sent to the prior payer is denied on routing alone.
Insurers and third-party administrators must approve or deny a claim within 21 calendar days when submitted electronically and 30 calendar days when submitted by other means, and must pay an approved claim within that same period measured from receipt. Any additional information must be requested within 20 working days, after which the claim is reprocessed and paid on the same 21 or 30-day basis.
A claim may not be denied without a reasonable basis, and the denial notice must issue within 21 or 30 calendar days of receipt of all required information, stating the reason, the criteria applied and how to appeal. Interest accrues from the payment due date at the prime rate of the largest bank in Nevada plus 6 percent. The Division of Insurance may penalise a payer that fails to approve or deny within 60 working days and may suspend or revoke authority for repeat non-compliance.
Work injury care is priced from the medical fee schedule the Division of Industrial Relations updates annually, so the edition in force on the date of service governs. Bills are due within 90 days of the date of service and the insurer must pay or deny within 30 days of receipt. Nevada is an at-fault auto state with no PIP mandate and no auto medical fee schedule, so auto injury balances depend on medical payments coverage, health coverage and liability recovery.
Nevada Medicaid managed care now covers all 17 counties through five plans: Health Plan of Nevada, Anthem Blue Cross and Blue Shield Healthcare Solutions, SilverSummit Healthplan, Molina Healthcare of Nevada and CareSource. Around 75,000 rural members transitioned out of fee-for-service, Washoe and Clark County membership was redistributed, and LIBERTY Dental Plan of Nevada administers dental benefits.
MedStats Billing provides tailored billing solutions for a wide range of medical specialties, ensuring accurate coding, fewer denials, and faster reimbursementsto maximizes your revenue potential.
MedStats Billing handles Nevada Medicaid enrollment, MCO credentialing, AB 52 deadline tracking, interest recovery, denial challenges and workers’ compensation billing across Nevada, giving practices end-to-end RCM support in the state whose rules changed most in 2026.
Claims are scrubbed against Medicaid MCO and commercial carrier edits before submission to drive clean first-pass reimbursement.
Every claim is tracked against the 21 or 30-day approval and payment window, the 20-working-day information request limit, and the notice content the statute requires on any denial.
We calculate the interest owed from the payment due date at prime plus six and invoice for it, rather than waiting for a payer to include money nobody has quantified.
Working knowledge of Anthem Blue Cross and Blue Shield of Nevada, Health Plan of Nevada, Sierra Health and Life, Hometown Health, Aetna, Cigna and all five Medicaid managed care plans.
Whether you practise in Las Vegas, Reno, Henderson, Elko or Carson City, our workflows adjust seamlessly as your group grows across all 17 counties.
HIPAA-compliant data handling and controlled access protect patient health information and billing records at every stage.
We integrate smoothly with widely used EHR platforms to ensure accurate data flow from documentation to claim submission. This reduces manual errors, speeds processing, and supports cleaner reimbursements.
We work alongside leading systems including:
Schedule a complimentary billing assessment with MedStats Billing to uncover hidden revenue loss, confirm your workflows match the new AB 52 deadlines, and check that your Medicaid patients are being billed to the plan they were actually assigned in the 2026 transition.
Under Assembly Bill 52, passed in the 2025 legislative session, an insurer or third-party administrator has 21 calendar days to approve or deny a claim submitted electronically and 30 calendar days for a claim submitted by mail or other non-electronic means. The payment window overlaps the approval window: an approved claim must be paid within that same 21 or 30-day period after the claim was received, rather than 30 days after approval as under the previous rule.
Where a payer fails to pay within the statutory timeframe, interest accrues from the payment due date until the claim is paid. The statutory formula is the prime rate at the largest bank in Nevada, as ascertained by the Commissioner of Financial Institutions on the 1 January or 1 July immediately preceding the date payment was due, plus 6 percent. The Division of Insurance may also impose administrative penalties and, for repeat non-compliance, suspend or revoke the payer’s authority.
No. Insurers and third-party administrators must request any additional information within 20 working days of receiving the claim, and must not request resubmission of documentation that was already provided unless there is a legitimate reason. Repeat requests may not be used to delay payment unnecessarily. Once the requested information arrives, the claim must be reprocessed and paid within 21 days for an electronic claim or 30 days for a non-electronic one.
A claim may not be denied without a reasonable basis, and the notice must be issued within 21 calendar days for electronic submissions or 30 calendar days for paper, measured from receipt of all required information. The notice must include a clear explanation of the reason for denial, the criteria on which the denial was based and how those criteria were applied, and instructions for appeal or dispute resolution. Carriers must also maintain a formal process for providers to challenge denied claims.
Managed care expanded statewide to all 17 counties, moving roughly 75,000 rural members out of fee-for-service, and a fifth plan entered the market. The five MCOs are Health Plan of Nevada, Anthem Blue Cross and Blue Shield Healthcare Solutions, SilverSummit Healthplan, Molina Healthcare of Nevada and CareSource. Health Plan of Nevada stopped offering managed care in Washoe County and its members were redistributed, and Clark County membership was rebalanced, so 2025 plan assignments should not be relied on.
Work injury care is reimbursed from the medical fee schedule published and updated annually by the Division of Industrial Relations, so the edition in force on the date of service controls the allowable amount. Bills must be submitted within 90 days of the date of service, and the insurer must pay or deny within 30 days of receiving the bill. Because the schedule is reissued each year, pricing from a superseded edition is a common and avoidable source of reductions.
We serve practices and healthcare facilities across all 17 counties, including Las Vegas, Henderson, North Las Vegas, Reno, Sparks, Carson City, Boulder City, Mesquite, Elko, Fernley, Winnemucca, Ely, Pahrump and Fallon.
