Prior Authorization

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:

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.