Prior authorization rules by place of service

You must get prior authorization before you get certain services. That’s approval before you get care. Nevada Health Solutions (NHS) takes care of prior authorization for your plan. You can learn more about NHS by visiting www.nevadahealthsolutions.org.

Your doctor can contact Nevada Health Solutions for prior authorization by:

Prior authorization is required for:

In-Office or Freestanding Facilities

All hematology/​oncology services
Hyperbaric treatment
Orthotic & prosthetic appliances over $500
Radiology services: CT/CTA, Discography, MRI/MRA, PET Scans
Varicose veins
TMJ procedures orthognathic surgery
Physical*, speech and occupational therapy
Sleep Studies

End stage renal disease treatment facility

Dialysis

Home health and home infusion services

All skilled services in a home setting

Inpatient

All inpatient admissions (except 2 day Vaginal Deliveries and 4 day Cesarean Sections)
All admissions to skilled nursing, acute rehabilitation, and long term acute care facilities

Outpatient hospital

Hyperbaric treatment
Radiology services: CT/CTA, Discography, MRI/MRA, PET Scans
Hematology/​oncology services
Dialysis
Physical*, speech and occupational therapy
Sleep studies
All surgery & invasive diagnostic procedures performed in surgery area (except colonoscopy/​sigmoidoscopy)

Ambulatory surgery center

All outpatient surgery or procedures (except colonoscopy/​sigmoidoscopy)

Additional services

All transplant services (including consults)
All genetic testing
All air ambulance transports
Medical foods for inborn errors of metabolism
ABA Therapy (not a covered benefit for Hospitality Plan Unit 185)
Durable Medical Equipment items over $500 (whether rented or purchased)
All clinical trials

This table is only a general guideline to UHH Plans prior authorization requirements.

This list may be updated from time to time. It is the provider’s responsibility to check for updates. If the procedure billed is not the procedure approved, there may be no payment and the patient is not liable. The presence or absence of a procedure code and/or service on this list does not determine benefits or coverage for your patient. Verification of benefits and eligibility should be obtained by calling UNITE HERE HEALTH at 855-405-3863.

Notification only

Inpatient and Residential Behavioral Health services