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)
  • 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)
  • 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 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