Credentialing

Credentialing is the process of assessing and validating the qualifications of a licensed independent practitioner to provide services for our members.

The credentialing process complies with the National Committee for Quality Assurance (NCQA) credentialing standards, the credentialing requirement of the Centers for Medicare & Medicaid Services (CMS, formerly known as HCFA), and the State of Nevada Medicaid Contract.

Sierra Health and Life is the delegated credentialing agent for the following:

• Health Plan of Nevada, Inc.
• UnitedHealthcare Health Plan of Nevada Medicaid
• Sierra Health and Life Insurance Company, Inc.
• Sierra Healthcare Options, Inc.
• Behavioral Healthcare Options, Inc.
• Northern Nevada Health Network
• UnitedHealthcare – Nevada Market

Please note: Credentialing submission and approval does not guarantee participation with the health plan. Approved and signed physician contracts are required for participation.

Credentialing Quick Facts

• Not all providers require credentialing. Do you require credentialing?
• Providers that require credentialing must go through six (6) Primary Phases before they can join the network.
• If the provider has an active/up to date CAQH account, please submit this account number and ensure the applicable documents are uploaded.
  • Nevada Applications (required) may not be available through CAQH but can be uploaded into your account
  • What’s required for credentialing?
• Credentialing applications are reviewed but the Credentialing Committee which is a peer review body that includes representation by providers practicing in HPN’s network. The committee is also a multi-disciplinary committee with representation from various types of practitioners. They meet a minimum of ten (10) times per year.
• Practitioners are required to notify HPN within 15 days of any loss of licensure, loss of privileges or Medicare/Medicaid sanctions and exclusions.
• Provider Summary Guide: Credentialing

Contact information

E-mail: NVSierraCred@uhc.com

Phone: 702-242-7758

Fax: 702-242-7853

The following practitioner and Health Delivery Organization types, listed below, DO NOT require review through the credentialing process.

If your specialty type is on the below list, a letter of intent should be sent directly to the contracting team for review: Contracting@uhc.com.

*Providers should not see members until you receive a Welcome Letter indicating that the provider has been credentialed and added to the contract.*

Credentialing application requirements follow and complies with the National Committee for Quality Assurance (NCQA) credentialing standards, the credentialing requirement of the Centers for Medicare & Medicaid Services (CMS formerly known as HCFA), and the State of Nevada Medicaid Contract.

By joining a Nevada Network, the State of Nevada Standard Credentialing application is required submission.

• Initial Credentialing application
• Healthcare Delivery Organization (HDO)
• Re-Credentialing application
• Credentialing Cover Letter/Requirements

When applications are submitted for review, there is required documentation that must be included (or available in CAQH) to deem the application complete. If the application is not completed in its entirety and does not contain all required documentation as outlined below; we will not be able to initiate the application process and your documents will not be retained.