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 8 a.m. to 5 p.m. Pacific Time Monday through Friday.

All providers are required to submit their provider enrollment or re-enrollment applications electronically via the Online Provider Enrollment (OPE) tool at https://www.medicaid.nv.gov/hcp42/provider/Home/tabid/477/Default.aspx. Paper applications are not accepted.

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

• 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.
• Associated Providers List for Nevada Medicaid Provider Group Enrollment: This completed Associated Providers List must be consistent with the information listed on the application, and must be uploaded with the original submission in order for your application to be considered complete. Original signatures are required for each individual being linked to the group.
• 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 Nevada Medicaid.
• 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.
• Electronic Funds Transfer (EFT) Authorization Form

• Chapter 1: Getting Started
• Chapter 2: Initial Enrollment Application
• Chapter 2 Addendum: Ownership & Relationships Example
• Chapter 3: Revalidation and Updates

• Provider Revalidation Report: The Nevada Medicaid Provider Revalidation Report lists each provider and the date their next revalidation is due. To avoid contract termination, your revalidation application must be processed and approved prior to the revalidation due date. Providers can start their revalidation process up to a year in advance. Revalidations submitted prior to one year in advance will be returned.

• Web Announcement 3306: Hospital Presumptive Eligibility Annual Training Calendar Dates and Sign-up Guidelines for 2024
• 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.

• Pregnancy Presumptive Eligibility Participation Guidelines and Billing Instructions: Pregnancy Presumptive Eligibility Participation Guidelines and Billing Instructions.
• Pregnancy Presumptive Eligibility Provider Addendum: Qualified providers must complete and submit the Nevada Medicaid Presumptive Eligibility Provider Addendum.
• Pregnancy Presumptive Eligibility Training Sign-Up Sheet: Complete this form listing the employees that will be attending the mandatory training for Pregnancy 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.

Changes to any information presented on your enrollment documents must be reported to Nevada Medicaid 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, submit a completed Provider Enrollment Application.

• Please submit provider license updates via the secure Provider Web Portal or email to Nevada Medicaid at nv.providerapps@gainwelltechnologies.com for processing.
• Please email voluntary termination forms (FA-34) to Nevada Medicaid at nv.providerapps@gainwelltechnologies.com for processing.