2016 Nevada Medicaid Provider Survey [Web Announcement 1062]


Provider Web Portal Enhancement: Treatment History Search for DME, Vision, Audiology and Dental Provider Types [Web Announcement 1066]

Provider Enrollment

NEW: Provider Enrollment Online Application
Effective December 1, 2015, the web-based Online Provider Enrollment Portal is available for providers to complete new enrollment in Nevada Medicaid, revalidation and provider changes.

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Thank you for your interest in the Nevada Medicaid and Nevada Check Up Program. This page contains all of the information and forms you will need to become a Nevada Medicaid provider. If you have any questions, please contact the Provider Enrollment Unit at (877) 638-3472 from 8a.m. to 5p.m. Monday through Friday.

Effective 12/1/2015, access Online Provider Enrollment for individual, group or OPR enrollments.

All enrollment documents including attachments require an original signature from the provider or an authorized representative (use dark blue or black ink).

Required Enrollment Documents
  • Provider Enrollment Information_Booklet: All providers will need the information contained in this booklet, which includes common enrollment questions and information about out-of-state providers and provider groups.
  • Enrollment Checklists: Copies of certain documents must be included with your Provider Enrollment Packet (e.g., copy of professional certification, proof of insurance, background check). The Enrollment Checklists show required documentation for each provider type.
  • Business Associate Addendum (NMH-3820): This document must be signed and submitted with your Provider Enrollment/Re-Enrollment Packet if it is listed on the Provider Enrollment Checklist for your Provider Type and when requested by the Division of Health Care Financing and Policy (DHCFP) or Hewlett Packard Enterprise (HPE).
Online Provider Enrollment User Manual
Initial Enrollment Documents
Re-Enrollment Documents
Ordering, Prescribing and Referring Provider Enrollment Documents
Hospital Presumptive Eligibility Documents
  • Web Announcement 1008: Attention ALL Hospital Presumptive Eligibility Providers: Guidance Policy Available
  • Web Announcement 1006: Hospital Presumptive Eligibility Annual Training 2016 Calendar Dates and Sign-up Guidelines (Updated December 8, 2015)
  • Web Announcement 931 with Training Schedule: Hospital Presumptive Eligibility Annual Training Calendar Dates and Sign-up Guidelines (Updated September 10, 2015)
  • Web Announcement 861 with Training Schedule: Implementation of Hospital Presumptive Eligibility Option for Acute Care Hospitals (Provider Types 11 and 75)
  • Nevada Medicaid Hospital Presumptive Eligibility Provider Addendum: Qualified hospitals must complete and submit the Nevada Medicaid Hospital Presumptive Eligibility Provider Addendum.
  • Hospital Presumptive Eligibility Training Sign-Up Sheet: Complete this form listing the hospital employees that will be attending the mandatory training for Presumptive Eligibility. You will be notified by the DWSS in regards to the training dates and times. Keep in mind that each employee making PE determinations MUST be trained by DWSS and complete a competency examination prior to making ANY determinations.
Recommended Enrollment Documents
Enrollment Information for Behavioral Health Providers
Changes to Provider Information

Changes to any information presented on your enrollment documents must be reported to Hewlett Packard Enterprise within five business days.

  • To complete changes online, please login to the Secure Web Portal, and choose “Revalidate-Update Provider”.
  • To report a change in business ownership, resubmit a completed Provider Enrollment Application.
  • For all other changes, the Provider Information Change Form (FA-33) may be used.
Mailing Address

Mail completed enrollment forms and required documentation to Hewlett Packard Enterprise, Provider Enrollment Unit, P.O. Box 30042, Reno, NV 89520-3042

On this website and on documents posted herein:

Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes, descriptions and data are copyrighted by the American Medical Association (AMA) and the American Dental Association (ADA), respectively, all rights reserved. AMA and ADA assume no liability for data contained or not contained on this website and on documents posted herein.

CPT is a registered trademark ® of the AMA. CDT is a registered trademark ® of the ADA. Applicable FARS/DFARS apply.

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