New Requirements for Provider Re-enrollment
Beginning June 1, 2012, providers are required to re-enroll in Nevada Medicaid and Nevada Check Up once every 36 months. Providers who do not re-enroll within 60 days of the date on their notification will have their provider contract terminated. Please see Web Announcement 510.
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.
All enrollment documents including attachments
require an original signature from the provider or an authorized representative (use
dark blue or black ink).
Changes to Provider Information
Changes to any information presented on your enrollment documents must be reported to HP Enterprise Services
within five business days.
Mail completed enrollment forms and required documentation to HP Enterprise Services, Provider Enrollment Unit,
P.O. Box 30042, Reno, NV 89520-3042
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/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 HP Enterprise Services (HPES).
Initial Enrollment Documents
Ordering, Prescribing and Referring Provider Enrollment Documents
Hospital Presumptive Eligibility Documents
Recommended Enrollment Documents
Enrollment Information for Behavioral Health Providers