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Provider Revalidation Instructions (Individuals) - …

_____ FA-31A-I: Provider Revalidation Instructions ( individuals ) Page 1 of 3 04/12/2013 Nevada Medicaid and Nevada Check Up This document provides Instructions for completing the Provider Revalidation Application for Individual providers who have received a Revalidation letter. Please answer all questions as of the current date. Attach additional sheets if necessary to answer each question completely. Each additional sheet must display the relevant question number from the application. These Instructions are designed to clarify certain questions on the application.

a) Any hospital, skilled nursing facility, home health agency, independent clinical laboratory, renal disease facility, rural health clinic or health maintenance organization that participates in Medicare (Title XVIII);

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