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For Members
For Providers
Looking for a plan?
What is Medicaid?
United Healthcare Health Plan of Nevada Medicaid Plan logo. click to return to homepage.

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    • Case Management
    • Clinical Guidelines
    • Continuing Medical Education (CME) Credits
    • Counting Kicks During Pregnancy
    • Credentialing
    • Empanelment Reports
    • Fraud Waste and Abuse
    • Health Equity
    • HEDIS Measures
    • Influenza (Flu) Vaccine Decision-Making Guide
    • Join Our Network
    • Long-Acting Injectable Medications
    • Medical Policies
    • Medical Policies - Nevada Only
    • Online Provider Center
    • Opioid Programs and Resources
    • Pharmacy Benefits
    • Prior Authorizations
    • Provider Advocates
    • Provider Memos, Letters and Forms
    • Provider Summary Guide
    • Provider Training (PDF)
    • Quality Issues
    • Review Protocols
    • Tip Sheet: Get Adults’ Vaccinations Back on Track (PDF)
    • Transplant Guidelines
    • Drug List (PDF)
    • Searchable Drug List
    • Doctor / Provider
    • Pharmacy
    • Vision
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Provider Memos, Letters and Forms

Download and print the information you need.

  • Behavioral Health Outpatient Treatment Request Form (PDF)
  • Important Information Regarding EPSDT Services
  • Understanding Patient Satisfaction Reporting
  • Update to Health Plan of Nevada Medicaid’s Prenatal and Postpartum Bonus Program (PDF)
  • Medicaid Appointment Availability Standards including Behavioral Healthcare Options Quick Reference Guide (PDF)
  • Maternity Risk Screening Form (PDF)
  • Well-Child, Sick Child Fax Memo
  • Primary Care Physician Change Form (PDF)
  • Transplant Referral Fillable Form (PDF)
  • General Guidelines For Bone Marrow Transplant/Stem Cell Transplant Referrals (PDF)
  • General Guidelines For Heart Transplant Referrals (PDF)
  • General Guidelines for Kidney Transplant Referrals (PDF)
  • General Guidelines For Liver Transplant Referrals (PDF)
  • General Guidelines For Lung Transplant Referrals (PDF)

For Medicaid related forms provided by the Nevada Department of Health and Human Services, please visit medicaid.nv.gov.

If you do not find the information you’re looking for, please call 702-242-7088 or toll-free at 1-800-745-7065, Monday through Friday, 8 a.m. to 5 p.m. local time.

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