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Member Transfer Request

For member use only. Providers are prohibited from submitting member transfer requests.

Step 1: Search for Provider Office

Select Benefit Plan

Benefit Plan How to find a pediatric dentist

Enter Location

Step 2: Select Provider Office to be Assigned

Dentist NameOffice LocationMore InfoSelect

Step 3: Enter Member Details




By clicking “Submit”, I affirm that I am a Nevada Medicaid member. I acknowledge that use of this form by anyone other than the member named above is considered potentially fraudulent and may be subject to corrective action by the Plan.

Please only click Submit once