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Welcome Current and Future Nevada Medicaid Providers


  

Medicaid Centralized Credentialing

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Centralized Credentialing process is live
  • Credentialing is the process by which a provider is determined qualified to render services based on education, licensure, work history and other elements. Credentialing activities will be facilitated by Nevada Medicaid's contracted Credentialing Verification Organization (CVO), Verisys.
  • Credentialing differs from enrollment which determines an applicant/provider meets the screening requirements for fee-for-service enrollment. Enrollment activities are facilitated by Nevada Medicaid's contracted fiscal agent, Gainwell Technologies.

    Both enrollment and credentialing are governed by the Federal Code of Regulations (CFR), Nevada Medicaid Services Manual (MSM), contracted Managed Care Entities (MCEs) policies, and the National Committee for Quality Assurance (NCQA) standards.

    All applicants and providers MUST have an active Contract with Nevada Medicaid or have an active application under review with Nevada Medicaid before initiating the credentialing process with any of the MCEs. If an application is denied by Nevada Medicaid, credentialing will be denied.
         FAQs  

Get started & questions

  1. Ensure you have an active Contract with Nevada Medicaid or an active application under review. For information on this step, contact ProviderEnrollment@DHCFP.nv.gov. You may need to complete Division of Insurance Uniform Credentialing Forms.
  2. Contact each Managed Care Entity (MCE) with whom you wish to contract. If you have questions about your credentialing status of your application, contact the MCE.
  3. To submit additional information or documentation, contact Verisys: 1-855-743-6161
  • Anthem Blue Cross and Blue Shield:

     Provider Services: 844-396-2330

    Join Network

    Manuals, Directories and Training

  • Molina Healthcare of Nevada:

     Provider Relations: (833) 685-2103 (TTY/TDD: 711)

    Join Network  

    Provider Resources

    Provider Manual

  • SilverSummit Health plan:

    Provider Relations: 844-366-2880

    Join Network

    Provider Resources

    Provider Manual  

  • UnitedHealthcare Health Plan of Nevada Medicaid (HPN):

    Provider Services: 800-745-7065

    Join Network

    Provider Summary Guide (including a list of frequently called numbers)

  • LIBERTY (Dental):

    Provider Relations: 888-700-0643

    Join Network

    Provider Resource Library

For more information, see the FAQs

Centralized Credentialing Implementation Timeline

01/30/2023
12/06/2024
12/2024
02/2025
02/28/2025
Public Workshop
Public Webpage
Public Notifications
MCE Training & Testing
Go-Live
 

Goals

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  • Achieve a robust screening and validation process to ensure enrollment of qualified/quality providers.  
  • Primary source verification for credentialing providers to be done by a single Credentialing Verification Organization (CVO).
  • Streamline the process by  transitioning credentialing responsibility from each Managed Care Entity to a CVO.
  • Adhere to guidelines by the to National Committee for Quality Assurance (NCQA).
  • Align processing and outcomes of credentialing & recredentialing.
  • Streamline process to reduce administrative burden. 
  • Ensure compliance with federal regulations.
 

 

Resources/Links

  • 42 CFR 455 Subpart E 
  • Medicaid Services Manual
  • Public Workshop, 01/30/2023
  • FAQs
 

Contact Us

 

For project implementation, write to:

ProviderEnrollment@DHCFP.nv.gov
 
Upon implementation, the CVO contractor
will assume responsibility for responding to inquiries.
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