Provider Forms & Resources

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FORMS

Provider Addition Form
Provider Termination Form
Provider Demographic Change Form
Provider Contact Form
Claim and Authorization Reconsideration Form
Over-Under Large Claim Adjustment Form

Medical Prior Authorization Form
Pharmacy Pre-Authorization Form
Optum Rx Pharmacy Pre-Authorization Form

RESOURCES

Administrative Guidelines
Authorization Matrices
Non-Contracted Provider Policies
Provider Quick Reference Guide
Upload Your Photo for Our Provider Directory
DME In-Network Provider List – Statewide

SB 365 Third Party Groups-2024
Nevada Department of Corrections (NDOC) Claims Letter

Hometown Health Office Hours:
Monday – Friday, 8 a.m. to 5 p.m.

Live Person Telephone Hours:
Monday – Friday, 7 a.m. to 8 p.m.

24 Hour Recorded Assistance:
Toll Free 800-336-0123

775-982-3232

Toll Free 800-336-0123

Información en español 775-982-3242

TTY Relay Service 711

10315 Professional Circle, Reno, NV 89521

Get Directions

Hometown Health complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

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