Provider Summary Guide

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)
• 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)
• Durable Medical Equipment (DME) Large DME and Respiratory Equipment (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)
  • Commercial Medicaid Medical Necessity Request Form (PDF)
• Advanced Directives (PDF)
• Fraud Waste and Abuse (PDF)
• Frequently Used Forms (PDF)
• Claim Reconsideration Request Form
• Health Plan of Nevada Complaint Form
• Health Plan of Nevada I Speak Card
• Health Plan of Nevada Medicaid and Nevada Check Up Member Grievance Form
• Health Plan of Nevada Provider Grievance Form
• Health Plan of Nevada TOC COC Form
• Maternity Risk Screening Form
• Nevada Universal Prior Authorization and Referral Form
• Oncology Step Therapy Exception Prior Authorization Form
• Penalties for Violations of Terms of Use
• Terms of Use Acknowledgement Form
• Request for Allowables

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