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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