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 centeropens in a new tabopens in a new window or complete a Prior Authorization Form (PDF)opens in a new tabopens in a new window or a Pharmacy Prior Authorization Request Form (PDF)opens in a new tabopens in a new window.
Special authorization requests:
- ABA providers should submit this formopens in a new tabopens in a new window for Applied Behavioral Analysis (ABA) therapy authorization requests.
- Complete this formopens in a new tabopens in a new window for Behavioral Health Outpatient Treatment authorization requests.
- Submit an Oncology Step Therapy Exception formopens in a new tabopens in a new window for members with stage 3 or stage 4 cancer. Oncology requests should be submitted under urgent status through phone, fax or web portal.
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
Health Plan of Nevada providers must file an appeal within 180 days.
If you have any questions, call 1-800-745-7065 or sign in to the online provider centeropens in a new tabopens in a new window.
