Prior authorization is necessary to ensure benefit payment.
You may prescribe a health care service, treatment, equipment or medication to your patient which requires prior authorization. You may submit a prior authorization request through our online provider center or complete a prior authorization and referral form. For Applied Behavioral Analysis (ABA) therapy authorization requests, ABA providers should submit this form.
The goal is to ensure health plan members receive the most appropriate, medically necessary care. All requests are reviewed by a licensed physician or under the supervision of one. Furthermore, only a physician may deny a request.
You may file an appeal if coverage is denied. To appeal a decision, mail a written request to:
Health Plan of Nevada, Member Services, P.O. Box 15645, Las Vegas, NV 89114-5645.
Senior Dimensions providers must file an appeal within 60 days from the date the prior authorization is denied. Health Plan of Nevada providers must file an appeal within 180 days.