Enrollments

Enroll a New Provider to a Contracted Group

SSHP Provider Data Form (PDF)

(Template revised in 12/2024)

Please ensure that CAQH is current and accessible to the health plan for all practitioners

NV Standard Credentialing Application (PDF)

(Template revised in 12/2016)

If you do not have CAQH, we will need a completed NV Standard Credentialing Application

Behavioral Health Addendum NV (PDF)

(Template revised in 12/2016)

Behavioral Health Addendum must be completed in its entirety for any Behavioral Health enrollment.

Hospital – Facility Provider Application (PDF)

(Template revised in 01/2017)

If submitting a new facility or clinic, a credentialing application will be required along with the documents refer

Update Requested By

Enroll Multiple Providers to a Contracted Group

SSHP Roster Template (Excel)

(Template revised in 12/2024)

Please ensure that CAQH is current and accessible to the health plan for all practitioners.

NV Standard Credentialing Application (PDF)

(Template revised in 12/2016)

If you do not have CAQH, we will need a completed NV Standard Credentialing Application.

Behavioral Health Addendum NV (PDF)

(Template revised in 12/2016)

Behavioral Health Addendum must be completed in its entirety for any Behavioral Health enrollment.

Hospital – Facility Provider Application (PDF)

(Template revised in 01/2017)

If submitting a new facility or clinic, a credentialing application will be required along with the documents referenced on the last page of the applicationenced on the last page of the application.

Update Requested By