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Instructions for Completing Form FA-19 - Nevada

Instructions for Completing Form FA-19 - Nevada 2025

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The document is a Level of Care Assessment form for nursing facilities in Nevada, designed for Medicaid providers to evaluate the care needs of recipients. It includes sections for screening type, recipient and provider information, medical history, current medications, special needs, activities of daily living (ADLs), and instrumental activities of daily living (IADLs). The form must be submitted through the Provider Web Portal or faxed if the provider is not enrolled in Nevada Medicaid.

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Versions	Form popularity	Fillable & printable
2019	4.7 Satisfied (61 Votes)
2013	4.5 Satisfied (37 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the phone number for Anthem Blue Cross Nevada Medicaid?

Call Member Services at 1-844-396-2329 (TTY 711).

Is the health plan of Nevada the same as Medicaid?

Health Plan of Nevadas Medicaid Plan is now UnitedHealthcare Health Plan of Nevada Medicaid.

How do I find a Medicaid provider in Nevada?

Search for a Medicaid or Nevada Check Up doctor or provider online. Contact Member Services at 1-800-962-8074, TTY 711, Monday through Friday, 8 a.m. to 6 p.m. local time, to request a hard copy to be mailed to you.

How do I enroll in Medicaid of Nevada provider?

If you have any questions about enrollment, please call HPES at (877) 638-3472. When calling, select the prompts for Nevada Medicaid Provider and then Provider Enrollment. Enrollment forms are at (select Provider Enrollment from the Providers menu).

How do I contact Nevada Medicaid customer service?

Customer Service Center (877) 638-3472. Automated Response System (ARS) (800) 942-6511.

What is the phone number for BCBS Nevada Medicaid provider?

If you do not know who is the provider administrator is in your office, call the Customer Service Center at (877) 638-3472.

How do I change ownership of a Medicaid provider in Nevada?

Any change to ownership information will require a Change of Ownership (CHOW) submission. A CHOW must be submitted as a new Initial Enrollment application using the Online Provider Enrollment (OPE) tool. The EVS no longer allows changes to be made in the Ownership section, such as the removal of a previous owner.

Instructions for Completing Form FA-19 - Nevada 2025

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See more Instructions for Completing Form FA-19 - Nevada versions

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Got questions?

What is the phone number for Anthem Blue Cross Nevada Medicaid?

Is the health plan of Nevada the same as Medicaid?

How do I find a Medicaid provider in Nevada?

How do I enroll in Medicaid of Nevada provider?

How do I contact Nevada Medicaid customer service?

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People also ask

What is the phone number for BCBS Nevada Medicaid provider?

How do I change ownership of a Medicaid provider in Nevada?

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Instructions for Completing Form FA-19 - Nevada 2025

Here's how it works

How to modify Instructions for Completing Form FA-19 - Nevada online

See more Instructions for Completing Form FA-19 - Nevada versions

Complete this form in 5 minutes or less

Got questions?

What is the phone number for Anthem Blue Cross Nevada Medicaid?

Is the health plan of Nevada the same as Medicaid?

How do I find a Medicaid provider in Nevada?

How do I enroll in Medicaid of Nevada provider?

How do I contact Nevada Medicaid customer service?

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People also ask

What is the phone number for BCBS Nevada Medicaid provider?

How do I change ownership of a Medicaid provider in Nevada?

Related links

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