Provider Summary Guide

Download the Provider Summary Guide

• Table of Contents (PDF)
• Introduction (PDF)
• Product Overview (PDF)
• Frequently Called Numbers (PDF)
• Provider Administrative Requirements and Resources (PDF)
• Contracting and Credentialing (PDF)
• Benefits and Eligibility (PDF)
• Utilization Management (PDF)
• Medical Director (PDF)
• Quality Assurance/Risk Management (PDF)
• Quality Improvement (PDF)
• Claims (PDF)
• Member Rights and Responsibilities (PDF)
• New Medical Technology (PDF)
• Pharmacy Services (PDF)
  • Commercial Medicaid Medical Necessity Request Form (PDF)
• Mental Health/Substance Abuse (PDF)
• Health Education and Wellness/Population Health (PDF)
• Advanced Directives (PDF)
• Fraud Waste and Abuse (PDF)
• Frequently Used Forms (PDF)
  • Claim Reconsideration Request Form (PDF)
  • Nevada Universal Prior Authorization Form (PDF)
  • Oncology Step Therapy Exception Prior Authorization Form (PDF)
  • OPC Penalties for Violations of Terms of Use (PDF)
  • OPC Terms of Use Acknowledgement Form (PDF)
  • Request for Allowables
  • Sierra Health & Life Complaint Form (PDF)
  • Sierra Health & Life I Speak Card (PDF)
  • Sierra Health & Life Provider Grievance Form (PDF)
  • SHL TOC/COC Form (PDF)