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.
You will need Adobe® Reader to view any printable PDF document(s).
Click the button to the left to download a free copy of Adobe® Reader.
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.
Provider Documentation Reminders: (See Web Announcement 1125 for reminders that will assist providers in adhering to the documentation responsibilities required of each Nevada Medicaid/Nevada Check Up provider.)
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
- Business Associate Addendum (NMH-3820): This document must be signed and submitted with your Provider Enrollment/Revalidation 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.
- Advance Directives Compliance Self-Evaluation & Certification (NMH-3827): This form must be completed and submitted to DHCFP if it is listed on the Provider Enrollment checklist for your Provider Type.
- Civil Rights Compliance Self-Evaluation & Certification (NMH-3828): This form must be completed and submitted to DHCFP if it is listed on the Provider Enrollment checklist for your Provider Type.
Online Provider Enrollment User Manual
Initial Enrollment Documents
Ordering, Prescribing and Referring Provider Enrollment Documents
Hospital Presumptive Eligibility Documents
- Web Announcement 1164: Hospital Presumptive Eligibility Annual Training 2016 Calendar Dates and Sign-up Guidelines (Posted June 16, 2016)
- Web Announcement 1085: Hospital Presumptive Eligibility Annual Training 2016 Calendar Dates and Sign-up Guidelines (Updated April 7, 2016)
- Web Announcement 1008: Attention ALL Hospital Presumptive Eligibility Providers: Guidance Policy Available
- 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.
Mail completed enrollment forms and required documentation to Hewlett Packard Enterprise, Provider Enrollment Unit,
P.O. Box 30042, Reno, NV 89520-3042