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:
- Phone: 855-487-0353
- Fax: 702-691-5614
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 |
| Hospice Care (Inpatient and Outpatient) |
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 therapies |
| 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 |