How do I become a provider for Saint Mary’s Health Plans?
Click here for more information about how to become an SMHP provider.
How long is the credentialing/contracting process?
The entire process, from the letter of intent through credentialing and contracting, can take 90 to 120 days or longer depending on individual circumstances. It is advisable to notify us of your intent to become a provider as far in advance as possible.
Why does Saint Mary’s Health Plans need to credential providers in addition to Saint Mary’s Regional Medical Center?
Each healthcare entity is required to demonstrate compliance to applicable regulatory standards for their respective organizations (e.g. Joint Committee on Accreditation of HealthCare Organizations, National Committee for Quality Assurance, etc.). Saint Mary’s Health Plans credentials practitioners (e.g. physicians, allied health professionals) and providers (e.g. facilities, hospitals) to National Committee for Quality Assurance (NCQA) standards. Primary Source Verification (PSV) is required for specific elements in the credentialing and recredentialing process. Healthcare entities are unable to share PSV information. Therefore, the processing of all credentialing information is required of each healthcare entity, respectively.
Nevada has implemented the Nevada Standardized Initial Application; a statewide credentialing application utilized by approximately 30 entities throughout Nevada. Practitioners complete this application once and distribute copies to each entity for which they are applying. In addition, Northern Nevada has also implemented a standardized community recredentialing cycle, allowing practitioners to be recredentialed at the same time by a number of healthcare entities.
For additional information regarding Saint Mary’s Health Plans credentialing and recredentialing, please contact our Credentialing department at 775.770.6172.
If I have my APN or PA contracted and credentialed, how do I bill for their services?
Services provided by physician extenders who have completed the credentialing and contracting process can be billed on a HCFA-1500 under their name as the Provider of Service (box 31) as long as the Tax Identification Number (TIN) for which they were contracted is also provided in box 25.
How can I verify which products I’m contracted for and my effective date?
Please contact the Provider Relations department at 775.770.6278.
How can I verify what my contracted allowable is for a particular code?
The Provider Relations staff can provide you with this information and, if necessary, send you a copy of your contract.
As a contracted provider, how do I open or close my practice to new patients?
Mail or fax a brief letter to the attention of “Provider Relations” detailing your desire to open or close your practice to new members, which product the change applies to and the effective date of the change.
How do I notify Health Plans of changes in my address, phone or Taxpayer Identification Number?
We ask that changes be communicated in writing with the effective date of the change. These can be mailed or faxed to the attention of “Provider Relations”. With regard to address changes, please be specific if your mailing and or billing address is different from your physical address. Be aware that we cannot change a Taxpayer Identification Number without an updated IRS W-9 form. Click here (PDF) to access an electronic IRS W-9 form.
Do you accept claims electronically?
Yes, we currently offer electronic claims submission through our contracted clearinghouse Emedeon. Visit www.transact.emdeon.com to begin submitting claims electronically.
What should I do if I believe my claim has not been paid correctly?
Many claim payment issues can be resolved by our Member Services Department at 755.770.6680 or 866.500.2741. Our Provider Relations staff is also available to assist you with claims issues as well as any questions or concerns you may have.
How often are your Provider Directories updated?
Provider Directories are updated each month and are available here or by contacting the Provider Relations Department.
