Prior authorization is necessary to ensure benefit payment.
Providers may prescribe a health care service, treatment equipment or medication which requires review and approval. This process is called prior authorization, and the goal is to ensure you receive the most appropriate, medically necessary care.
All requests requiring a medical or clinical decision are reviewed by a licensed physician or under the supervision of one. Furthermore, only a physician may deny a request. To learn more, health plan members can review their plan documents or sign in to the online member center.
Health plan members or their provider may file an appeal if coverage is denied. To appeal a decision, they can call Member Services or mail a written request within 180 days from the date of the denial to: Member Services, Health Plan of Nevada, P.O. Box 15645, Las Vegas, NV 89114-5645.
For Applied Behavioral Analysis (ABA) therapy authorization requests, ABA providers should submit this form.