Become a Nevada Health Plan Provider: A Step-by-Step Guide

Medical providers are reimbursed at higher rates if they contract with health plans. Plan members also have a lower out-of-pocket expense when they utilize a participating provider. Therefore, it is to the advantage of a provider to contract with health plans dominant in the area.

Instructions

• 1

  Contact leading health plans in your area and tell them that you are interested in joining their network as a participating provider.

• 2

  Initiate the credentialing process by completing each health plan's credentialing application.

• 3

  Complete the Council for Affordable and Quality Healthcare (CAQH) credentialing application. Although not required by all health plans, the CAQH universal credentialing application is used by many health plans, including Aetna.

• 4

  Submit your credentialing application with all attachments. Include copies of your medical license, Drug Enforcement Agency (DEA) certificate, resume, proof of hospital privileges and proof of your tax ID number.

• 5

  Negotiate and sign your participating provider agreement.