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    • Clinical Guidelines
    • Counting Kicks During Pregnancy
    • Dental Provider Guide
    • Health Care Forms
    • HEDIS Measures
    • Influenza (Flu) Vaccine Decision-Making Guide
    • Join Our Network
    • Long-Acting Injectable Medications
    • Medical Policies
    • Online Provider Center
    • Online Provider Center Tutorial
    • Opioid Programs & Resources
    • Pharmacy Benefits
    • Pharmacy Policies
    • Prior Authorizations
    • Provider Advocates
    • Provider Summary Guide
    • Quality Issues
    • Review Protocols
    • Submit/Appeal a Claim
    • Tip Sheet: Get Adults’ Vaccinations Back on Track (PDF)
    • Transplant Guidelines
    • Utilization Management
    • Women's Preventive Services
    • Mail Order Program
    • Drug Lists
    • Dental
    • Doctor or Provider
    • Pharmacy
    • Vision

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 I Speak Card (PDF)
    • Sierra Health & Life Provider Grievance Form (PDF)
    • SHL TOC/COC Form (PDF)
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