Skip navigation
SIGN IN
For Members
For Providers
For Employers
For Brokers / Agents
Medicaid
I NEED HELP WITH
Clinical Guidelines
Counting Kicks During Pregnancy
Dental Provider Guide
Health Care Forms
HEDIS Measures
Influenza (Flu) Vaccine Decision-Making Guide
Join Our Network
Long-Acting Injectable Medications
Medical Policies
Online Provider Center
Online Provider Center Tutorial
Opioid Programs & Resources
Pharmacy Benefits
Pharmacy Policies
Prior Authorizations
Provider Advocates
Provider Summary Guide
Quality Issues
Review Protocols
Submit/Appeal a Claim
Vaccinations, Getting Adults Back on Track
(PDF)
Transplant Guidelines
Utilization Management
Women's Preventive Services
DRUG LIST
Mail Order Program
OptumRx Website
3-Tier Large Group Plan Preferred Drug List (employers with 51+ employees)
(PDF)
4-Tier HPN Balance Preferred Drug List
(PDF)
4-Tier Large Group Plan Preferred Drug List (employers with 51+ employees)
(PDF)
4-Tier Small Group Plan Preferred Drug List (for employers with 2-50 employees)
(PDF)
4-Tier Individual Plan Preferred Drug List
(PDF)
Drug Lists
Care Options
Dental
Doctor or Provider
Pharmacy
Vision
For Members
For Providers
For Employers
For Brokers / Agents
Medicaid
SIGN IN
Provider Summary Guide
Download the Provider Summary Guide:
Table of Contents (PDF)
Introduction (PDF)
Overview of Health Plan of Nevada (PDF)
Frequently Called Numbers (PDF)
Provider Administrative Requirements and Resources (PDF)
Credentialing (PDF)
Member Rights and Responsibilities (PDF)
Benefits and Eligibility (PDF)
Medicaid and Nevada Check Up (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)
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)
Durable Medical Equipment (DME) Large DME and Respiratory Equipment (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 (PDF)
New Medical Technology (PDF)
Pharmacy Services (PDF)
Commercial Medicaid Medical Necessity Request Form (PDF)
Advanced Directives (PDF)
Fraud Waste and Abuse Compliance Policy (PDF)
Frequently Used Forms (PDF)
Frequently Used Forms
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 TOC COC Form
Maternity Risk Screening Form
Nevada Universal Prior Authorization and Referral Form
Oncology Step Therapy Exception Prior Authorization Form
Penalties for Violations of Terms of Use
Terms of Use Acknowledgement Form
Request for Allowables
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