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

  
  

CHANGE IS COMING!

We are excited to announce Provider Flex, our streamlined, intuitive, integrity-based provider enrollment solution. This exciting new tool will be available to all providers by mid- 2025.