Requirement to use Uniform Credentialing Form NDOI-901 & Associated Form

Carson City: 1818 E. College Parkway, Suite 103 Carson City, Nevada 89706 - Telephone (775) 687-0700 - Fax (775) 687-0797 Las Vegas: 3300 W. Sahara Avenue, Suite 275 Las Vegas, Nevada 89102 - Telephone (702) 486-4009 - Fax (702) 486-4007 DOI.NV.GOV STATE OF NEVADA DEPARTMENT OF BUSINESS AND INDUSTRY DIVISION OF INSURANCE Bulletin 25-004 October 13, 2025 Requirement to use Uniform Credentialing Form NDOI-901 & Associated Forms The Division issues this Bulletin to remind each insurer, carrier, society, corporation, health maintenance organization and managed care organization to use the Nevada Division of Insurance (NDOI) Form 901 prescribed by the Commissioner of Insurance pursuant to NRS 629.095 when obtaining any information related to the credentials of a provider of health care. The Division, with the help of the Commissioner’s Life and Health Advisory Sub-Committee, has recently updated NDOI-901 and introduced new forms entitled the Uniform Credentialing Form – Addendum (NDOI-901A) and the Facility Credentialing Application (NDOI-901B). All of these forms are posted on the Division’s website at https://doi.nv.gov/Insurers/Life- Health/, and their purpose is to provide a single consolidated form for use by applicants for participation as a provider with health plans or health insurers and may be used for hospital and other healthcare organization medical staff membership and clinical privileges. For any additional information that must be requested for credentialing, please see NAC 679B.0405. ______________________________ NED GAINES Commissioner of Insurance JOE LOMBARDO Governor DR. KRISTOPHER SANCHEZ Director NED GAINES Commissioner