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. Paper applications are not accepted.

All enrollment documents require an electronic signature from the provider or owner. As part of the DocuSign signature process, the signer will be required to upload an image of their state issued license (front and back) and include a liveness video for validation (excluding associated providers). Please refer to Web Announcement 3632 for details.

Table of Contents

• Enrollment Information




• Revalidation Report




• User Guides




• Training Materials




• Hospital Presumptive Eligibility Documents




• Pregnancy Presumptive Eligibility Documents




• Provider License Updates and Voluntary Terminations Only




• News and Updates

Archives

• Enrollment Information Booklet
• Enrollment Checklists
• 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.

• 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.

• Getting Started




• Group Application




• Ownership and Disclosure Addendum




• Individual Application




• Revalidation and Updates

If you would like to register for training opportunities, click on the Provider Training Portal button below to access the Absorb Learning Management System (LMS) and enroll in one of the sessions. For information on registering, logging in, and navigating the Absorb LMS please click the Tip Sheet button below.

• 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.

• 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.