Download the Provider Summary Guide:
- Table of Contents (PDF)
- Introduction (PDF)
- Product Overview (PDF)
- Frequently Called Numbers (PDF)
- Provider Administrative Requirements and Resources (PDF)
- Contracting and Credentialing (PDF)
- Member Rights and Responsibilities (PDF)
- Benefits and Eligibility (PDF)
- Medicaid (PDF)
- Utilization Management (PDF)
- Referrals to Specialists (PDF)
Southern Nevada Referral Guidelines
- Bariatric Surgery Guidelines (PDF)
- Cardiology Guidelines (PDF)
- Cardiovascular Surgery Guidelines (PDF)
- Dermatology Guidelines (PDF)
- Endocrinology Guidelines (PDF)
- ENT Guidelines (PDF)
- Gastroenterology Guidelines (PDF)
- Gastroenterology - Pediatric Guidelines (PDF)
- General Surgery Guidelines (PDF)
- Nephrology Guidelines (PDF)
- Neurology Guidelines (PDF)
- Ophthalmology Guidelines (PDF)
- Orthopedic Guidelines (PDF)
- Pain Management Guidelines (PDF)
- Perinatology Guidelines (PDF)
- Plastic Surgery Guidelines (PDF)
- Podiatry Guidelines (PDF)
- Rheumatology Guidelines (PDF)
- Urology - Adult Guidelines (PDF)
- Urology - Pediatric Guidelines (PDF)
Southern Nevada Support Services
- Radiology (PDF)
- Laboratory (PDF)
- Speech Therapy (PDF)
- Physical Therapy / Occupational Therapy (PDF)
- Optometry (PDF)
- Home Health (PDF)
- Palliative Care (PDF)
- Hospice (PDF)
- Durable Medical Equipment (DME) Specialty Rehabilitation and Home Infusion Services (PDF)
- Transitional Care Admissions (Subacute and SNF) (PDF)
- Breast Care Program (PDF)
- Wound Care (PDF)
- Closed Observation Unit (PDF)
- Claims (PDF)
- Quality Assurance - Risk Management (PDF)
- Quality Improvement (PDF)
- Medical Director (PDF)
- Mental Health - Substance Abuse (PDF)
- Health Education and Wellness / Population Health (PDF)
- New Medical Technology (PDF)
- Pharmacy Services (PDF)
- Advanced Directives (PDF)
- Fraud Waste and Abuse (PDF)
- Frequently Used Forms (PDF)
- Claim Reconsideration Request Form
- Health Plan of Nevada I Speak Card
- Health Plan of Nevada Provider Grievance Form
- Health Plan of Nevada Referral Form
- Health Plan of Nevada TOC COC Form
- Maternity Risk Screening Form
- Nevada Universal Prior Authorization Form
- Oncology Step Therapy Exception Prior Authorization Form
- Penalties for Violations of Terms of Use
- Terms of Use Acknowledgement Form
- Request for Allowables
- Primary Care Physician Change Form
Additional forms applicable to Southern Nevada providers only:
- SMA Imaging Services Exam Request Form
- SMA Imaging Services Expectation Sheet
- SMA Imaging Services Expectation Sheet - CT
- SMA Imaging Services Expectation Sheet - Dexa Bone Density
- SMA Imaging Services Expectation Sheet - FLOURO
- SMA Imaging Services Expectation Sheet - HSG
- SMA Imaging Services Expectation Sheet - IVP
- SMA Imaging Services Expectation Sheet - Mammogram
- SMA Imaging Services Expectation Sheet - Myelogram
- SMA Imaging Services Expectation Sheet - Ultrasound
