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Credentialing

Thank you for your interest in becoming a network provider for Health Plan of Nevada, Inc. / Sierra Health & Life Insurance Company, Inc.

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.

Sierra Health and Life is the delegated credentialing agent for the following:

  • Health Plan of Nevada, Inc.
  • UnitedHealthcare Health Plan of Nevada Medicaid
  • Sierra Health and Life Insurance Company, Inc.
  • Sierra Healthcare Options, Inc.
  • Behavioral Healthcare Options, Inc.
  • Northern Nevada Health Network
  • UnitedHealthcare – Nevada Market

Please note: Credentialing submission and approval does not guarantee participation with the health plan. Approved and signed physician contracts are required for participation.

Credentialing Quick Facts

  • Not all providers require credentialing. Do you require credentialing?
  • Providers that require credentialing must go through six (6) Primary Phases before they can join the network.
  • If the provider has an active/up to date CAQH account, please submit this account number and ensure the applicable documents are uploaded.
  • Credentialing applications are reviewed but the Credentialing Committee which is a peer review body that includes representation by providers practicing in HPN’s network. The committee is also a multi-disciplinary committee with representation from various types of practitioners. They meet a minimum of ten (10) times per year.
  • Practitioners are required to notify HPN within 15 days of any loss of licensure, loss of privileges or Medicare/Medicaid sanctions and exclusions.
  • Provider Summary Guide: Credentialing

Contact information

E-mail: NVSierraCred@uhc.com

Phone: 702-242-7758

Fax: 702-242-7853

Credentialing Requirements

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

The following practitioner and Health Delivery Organization types, listed below, DO NOT require review through the credentialing process.

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

The Six (6) Primary Phases to Join the Network

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

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.

Sierra Health and Life is the delegated for Nevada based networks.

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.