Before you submit a non-plan provider claim form to us, find out if it's necessary. Many providers will submit claims even if they're not in our network. This is why it's important to show your health plan ID card at each appointment.
If you're asked to submit the claim, please complete Section 1 of the non-plan provider claim form. Your provider must fill out Section 2.
In addition, please include copies of any applicable itemized bills and/or receipts from your provider.
Items that will not be accepted for reimbursement include, but are not limited to, billing statements indicating balance due or credit card receipts.
Health Plan of Nevada
P.O. Box 15645
Las Vegas, NV 89114-5645