Credentialing With Each Nevada Medicaid Managed Care Plan

Your plan list depends on where you see patients. Per Nevada Medicaid's Statewide Managed Care Q&A (Web Announcement 3753):

Health Plan of Nevada stopped offering Medicaid managed care in Washoe County on January 1, 2026, and its members there moved to the other four plans (SilverSummit). A Las Vegas practice may need all five contracts; a practice in Elko needs two.

No Nevada MCO will start credentialing until you are enrolled in Nevada Medicaid fee-for-service, or at least have an application under review. Nevada Medicaid states that everyone serving Medicaid recipients, under fee-for-service or an MCO, must be enrolled as a Nevada Medicaid provider to be paid (Nevada Medicaid provider FAQ). SilverSummit's 2026 manual repeats the rule for practitioners, facilities and clinics alike (SilverSummit 2026 Provider Manual). For the full state process, see our Nevada Medicaid provider enrollment guide.

Enrolling in fee-for-service does not commit you to seeing fee-for-service patients. It is simply the state screening layer every plan relies on, and centralized credentialing does not replace it (Web Announcement 3324).

What to know about state enrollment in 2026:

• The agency has a new name. The Division of Health Care Financing and Policy (DHCFP) now operates as Nevada Medicaid under the Nevada Health Authority (NVHA). Policy emails now use the @nvha.nv.gov domain.
• Applications go through Provider Flex. Gainwell Technologies, the fiscal agent, runs the Provider Flex enrollment tool linked from medicaid.nv.gov. Paper applications are not accepted.
• Use the same NPI you will credential. Enroll each individual (Type 1 NPI) and the billing group or facility (Type 2 NPI) exactly as you plan to contract with the MCOs. A mismatch here is the most common reason an MCO stalls a file.
• Pull your provider-type checklist first. Required attachments differ by provider type, and missing ones send the application back.
• Contacts: Gainwell Provider Enrollment, (877) 638-3472; Nevada Medicaid enrollment policy, providerenrollment@nvha.nv.gov.

Once Nevada Medicaid has your file, you can open applications with the MCOs in parallel.

Contracting is still plan by plan, but verification happens once. Nevada Medicaid signed its CVO contract with Verisys (formerly Aperture) in March 2024 (Web Announcement 3324), and effective February 28, 2025, every Nevada Medicaid plan must use the centralized process (Health Plan of Nevada).

The sequence for a practitioner, as SilverSummit's 2026 Provider Manual describes it:

1. 1

   Apply to the plan

   You submit the plan's own participation application (contracting request).

2. 2

   Plan requests credentialing

   Once the plan accepts the application, it sends a credentialing request to Verisys.

3. 3

   Verisys verifies

   Verisys pulls your CAQH ProView profile, performs primary source verification (PSV) and queries state and federal databases.

4. 4

   Standards review

   Verisys measures the results against NCQA standards, CMS guidelines and Nevada Medicaid requirements.

5. 5

   Committee decision

   A single centralized Credentialing Committee, facilitated by Verisys, makes the decision.

6. 6

   Contract loaded

   The plan notifies you of the result and finishes loading your contract.

Because verification and the committee are shared, each plan no longer runs its own primary source verification on you. Nevada's stated aim is to cut repetitive work and shorten the burden of credentialing with multiple MCOs.

What you need before you apply

Individual practitioners authorize the plans to view their CAQH profile. At minimum, CAQH must hold:

• A completed, signed and dated Nevada credentialing application
• A signed attestation no more than 120 days old covering license history, discipline, felony convictions, substance use, and physical and mental fitness
• Current malpractice face sheet with coverage amounts and dates
• A current license for every state where you practice
• DEA registration and any state controlled-substance certificate
• A CV with at least five years of work history, with gaps explained
• Proof of highest education or post-graduate training
• CLIA certificate, if applicable

Facilities, hospitals, clinics and ancillary providers do not use CAQH. Verisys sends them a Nevada Facility Credentialing application, which needs facility licensure, other licenses (CLIA, DEA, pharmacy), general liability coverage, and accreditation from a body such as The Joint Commission or, if unaccredited, a government site survey.

Every plan also requires a Disclosure of Ownership and Control Interest Statement naming anyone with a 5% or greater ownership or control interest, per 42 CFR 455.104–106.

Turnaround and your rights

Nevada does not publish a guaranteed credentialing timeline. Delays usually come from an incomplete or expired CAQH profile, a license or insurance policy expiring mid-review, or slow responses to Verisys outreach. Plans notify you of approval within 30 calendar days of receiving the CVO result, and of adverse decisions within 14 calendar days (SilverSummit). For typical payer timelines, see how long payer credentialing takes in Nevada.

You can check status or correct information directly with Verisys at (855) 743-6161 or outreachsupport@verisys.com. A practitioner denied by the centralized committee cannot reapply for one year.

Each MCO is your front door: you request participation from the plan, and the plan triggers Verisys. Here is what is different about each one.

Anthem Blue Cross and Blue Shield Healthcare Solutions

Anthem (an Elevance Health plan) serves urban Clark and urban Washoe counties. Start with the Join Our Network request on Anthem's Nevada provider site; Anthem's provider tools run through Availability Essentials. Keep your CAQH profile current and authorized for Anthem before submitting, since Anthem cannot send your file to Verisys without it. Phone: (844) 396-2329.

CareSource

CareSource is the newest plan, added January 1, 2026, and the only nonprofit MCO in the program (KOLO). It serves urban Clark, urban Washoe and every rural and frontier county, which makes it essential for rural practices. CareSource's Nevada provider manual confirms Verisys handles its primary source verification and may contact you directly. To join, contact the network team at NvhpEngagementTeam@CareSource.com or (833) 230-2112, or start at caresource.com/nv/providers/medicaid (Web Announcement 3815).

Health Plan of Nevada (UnitedHealthcare)

HPN now serves Medicaid members in urban Clark County only. Its credentialing is handled by affiliate Sierra Health and Life as delegated agent. For Medicaid, HPN says you still submit your application directly to UHC HPN Medicaid, and its team forwards the file to Verisys for verification and committee review (Health Plan of Nevada). Expect outreach from Verisys after you apply. HPN's commercial credentialing is a separate process with its own committee, so a commercial approval does not make you Medicaid-participating.

Molina Healthcare of Nevada

Molina serves urban Clark and urban Washoe counties. Apply through Molina's Nevada Medicaid join-the-network page; the Nevada provider line is (833) 685-2103 (Nevada Medicaid MCO FAQ). Molina members' vision and pharmacy benefits run through separate vendors, so confirm whether a carve-out applies to your specialty before assuming your medical contract covers it.

SilverSummit Healthplan

SilverSummit (a Centene plan) is the only MCO besides CareSource that serves all of Nevada, urban, rural and frontier. Its process is the most fully documented in its 2026 Provider Manual:

• New groups submit the SilverSummit participation Application form.
• Adding a practitioner to an existing group contract uses the Provider Data Quality (PDQ) Request Form, which is also how you report address, TIN and NPI changes.
• A Provider Relations Specialist contacts you within 30 days of your effective date for orientation.
• Network team: NETWORKMGMTNV@SilverSummitHealthPlan.com or (844) 366-2880.

SilverSummit's manual also states that contracted rates may not fall below the published Medicaid fee-for-service rate unless both parties agree otherwise, a useful benchmark when reviewing any MCO contract.

Dental is a separate credential

MCO members receive dental benefits through LIBERTY Dental Plan of Nevada, a prepaid ambulatory health plan, not through the medical MCO. Dentists and oral surgeons billing dental codes need a LIBERTY contract in addition to, or instead of, the medical plans.

All five plans use Verisys for verification; what differs is where they operate and how you start.

Centralized CVO for all five: Verisys, (855) 743-6161, outreachsupport@verisys.com. Phone numbers change; confirm them on each plan's provider site before calling.

Staying billable means running two separate clocks: MCO recredentialing every 36 months and Nevada Medicaid revalidation on the state's own cycle. Missing either one ends your participation.

Verisys notifies you when recredentialing is due, and you can answer with a current CAQH profile rather than a new paper application (SilverSummit 2026 Provider Manual). For the state cycle, see our Nevada Medicaid revalidation guide.

Demographic changes, such as a new location, TIN, NPI or panel status, must go to every plan you participate with, not just one. Under centralized credentialing, Verisys holds your credentials but each MCO still maintains its own provider directory and claims setup.

Most stalled files trace back to data that does not match across systems or a document that expires mid-review.

Credentialing checklist

• Active Type 1 and Type 2 NPIs with matching taxonomy in NPPES
• Nevada Medicaid enrollment approved or pending in Provider Flex
• Plans selected for each county you serve
• CAQH ProView complete, attested within 120 days, all Nevada MCOs authorized
• Nevada license, DEA, state controlled-substance certificate and malpractice current
• CV with five years of work history and gaps explained
• Ownership and control disclosure prepared for anyone at 5% or more
• Participation application sent to each plan, with dates logged
• Verisys outreach monitored at outreachsupport@verisys.com
• Signed contract and effective date confirmed per plan before billing
• Recredentialing and revalidation dates on a shared calendar

Nevada's 2026 model rewards practices that work in order: state enrollment, the right plans for your counties, a clean CAQH profile, then one participation request per plan, with Verisys doing the verification behind the scenes. Get the sequence wrong and every MCO claim from your first months can deny as out of network.

If you would rather not manage five plan pipelines, Verisys outreach and two renewal calendars in-house, talk to our credentialing team about handling Nevada Medicaid enrollment and MCO contracting for your practice.