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.
Please note: Credentialing submission and approval does not guarantee participation with the health plan. Approved and signed physician contracts are required for participation.
E-mail: NVSierraCred@uhc.com
Phone: 702-242-7758
Fax: 702-242-7853
The following practitioners and Health Delivery Organization types require review through the credentialing process.
Practitioners that require credentialing:
Advanced Registered Nurse Practitioner (ARNP)
Audiologist (AUD)
Certified Family Nurse Practitioner (CFNP)
Certified Alcohol & Drug Counselor (CADC)
Certified Nurse Midwife (CNM)
Registered Addiction Specialist (RAS)
Doctors of Oriental Medicine (OMD)
Certified Social Worker (CSW)
Licensed Clinical Alcohol & Drug Counselor (LCADC)
Doctor of Chiropractic (DC)
Licensed Alcohol & Drug Counselor (LADC)
Doctor of Medicine (MD)
Licensed Social Worker (LSW)
Doctor of Oral Surgery (OS)
Physician Assistants/Certified
Doctor of Osteopathy (DO)
Doctor of Optometry (OD)
Doctor of Philosophy (PhD)
Nurse Practitioners (NP)
Doctor of Podiatric Medicine (DPM)
Occupational Therapist (OT)
Doctor of Psychology (PsyD)
Speech Pathologists (SLP)
Licensed Marriage & Family Therapist (LMFT)
Physical Therapists (PT)
Clinical Professional Counselor (CPC)
Nutritionist/Registered Dietician
(including Certified Diabetic Educator) (DT/RDT)
Health Delivery Organization (HDO) that require credentialing:
Comprehensive Outpatient Rehabilitation Facilities
DME
Free Standing Surgical Centers
Home Health Agency
Hospitals
Inpatient Behavioral Health Facilities
Laboratories
Nursing Homes
Orthotics/Prosthetics
Providers of End-Stage Renal Disease Services
Radiology (Facilities and Portable Services)
Residential Behavioral Health Facilities
Skilled Nursing
Sleep Study Centers
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.
Practitioners that DO NOT Require Credentialing:
Anesthesiologists
Board Certified Behavior Analysts
Certified Registered Nurse Anesthetists
Dentists who are not Oral Surgeons
Hospital Based Only (Emergency Room)
Hospitalist
Neonatologists
Pathologists
Pharmacist
Radiologists
Registered Behavioral Therapists
Respiratory Therapists
Urgent Care Only Providers
1. The contracting team must have an active/approved letter of intent on file for the group. Do you need to submit a letter of intent? Click here to get started.
2. To add a provider to your group contract, complete the add request form and send to Contracting@uhc.com and NVSierraCred@uhc.com. Please note: BHO providers must submit the completed add request form to providerrelations@bhoptions.com.
3. The contract and credentialing team receives the request. To deem your application complete, all required documentation must be included (or available in CAQH) at the time of submission. What's required?
4. The credentialing team completes primary source verification through various state agencies.
5. The provider/facility credentialing file is reviewed by the credentialing committee.
6. The contracting team is notified of Committee decisions. Final review is completed by the contracting team.
*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.
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.