Culinary Health Fund prior authorization rules
Prior authorization rules by place of service
For Prior Authorization, please contact NEVADA HEALTH SOLUTIONS:
Telephone: 702-216-1653
Toll Free: 855-487-0353
Fax: 866-201-5601
https://www.nevadahealthsolutions.org
PLEASE BE ADVISED THAT THE CULINARY HEALTH FUND DOES NOT HAVE OUT OF AREA/NETWORK BENEFITS AND REQUIRES ALL PROVIDERS TO REFER TO IN-NETWORK PROVIDERS. FOR A CURRENT LIST OF PROVIDERS PLEASE GO TO www.CulinaryHealthFund.org OR CALL CUSTOMER SERVICE AT 702-733-9938.
In Office or Freestanding Facility
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CARDIOLOGY SERVICES |
ALL CARDIOLOGY SERVICES MUST BE PROVIDED BY HEART CARE IPA (HEART CENTER OF NEVADA AND NEVADA HEART & VASCULAR CENTER). CARDIAC IMAGING SERVICES DO NOT REQUIRE PRIOR AUTHORIZATION WHEN PERFORMED BY THESE EXCLUSIVE PROVIDERS. |
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CUSTOM COMPRESSION STOCKINGS* |
AUTHORIZATION REQUIRED |
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CYBERKNIFE |
NO AUTHORIZATION REQUIRED WHEN PERFORMED BY COHEN, CURTIS, FARZIN, MEOZ AND SCHWARTZ (TIN: 27223260) |
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DME* |
Durable medical equipment items that are over $500 require authorization (whether it is a rental or purchase, to include oxygen equipment over $500, i.e. oxygen concentrators) |
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HOME EEG MONITORING |
AUTHORIZATION REQUIRED |
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HEMATOLOGY/ONCOLOGY SERVICES |
ALL HEMATOLOGY/ONCOLOGY NOT PROVIDED BY COMPREHENSIVE CANCER CENTERS OF NEVADA REQUIRES PRIOR AUTHORIZATION. |
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HYPERBARIC TREATMENT |
AUTHORIZATION REQUIRED |
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LABORATORY SERVICES |
CLINICAL PATHOLOGY LABORATORIES IS THE CULINARY HEALTH FUND'S EXCLUSIVE LABORATORY PROVIDER AND MUST BE USED FOR ALL OUTPATIENT LABORATORY SERVICES |
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LABORATORY - ALL GENETIC TESTING* |
AUTHORIZATION REQUIRED |
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OFFICE ADMINISTERED DRUGS |
DRUGS INDICATED REQUIRE AUTHORIZATION: |
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ORTHOTIC & PROSTHETIC APPLIANCES* |
Orthotic & Prosthetic Appliances that are over $500 require authorization |
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RADIOLOGY SERVICES |
DESERT RADIOLOGISTS IS THE CULINARY HEALTH FUND'S EXCLUSIVE RADIOLOGY SERVICES PROVIDER. SERVICES PERFORMED AT DESERT RADIOLOGISTS DO NOT REQUIRE AUTHORIZATION WITH THE EXCEPTION OF PET SCANS. |
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For Radiology Services NOT performed at Desert Radiology authorization is required for: CT/CTA, Discography, Some Obstetrical Ultrasounds, Fetal Biophysical Profiles, MRI/MRA, PET Scans |
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SLEEP STUDIES |
NOCTURNA IS THE CULINARY HEALTH FUND'S EXCLUSIVE SLEEP STUDY PROVIDER. Requires authorization and must be ordered by a Cardiologist, ENT, Neurologist, Pulmonologist or Culinary Health Center - Primary Care. |
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SURGERY |
AUTHORIZATION REQUIRED FOR CERTAIN PROCEDURES. |
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VARICOSE VEINS |
AUTHORIZATION REQUIRED - LIMITED TO SELECT SPECIALTIES |
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TMJ PROCEDURES |
AUTHORIZATION REQUIRED |
HOME HEALTH AND HOME INFUSION SERVICES (PLACE OF SERVICE 12)
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AUTHORIZATION REQUIRED |
INPATIENT (PLACE OF SERVICE 21, 31, 61)
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ALL INPATIENT ADMISSIONS REQUIRE AUTHORIZATION, INCLUDING ELECTIVE ADMISSIONS AND THOSE RESULTING FROM ER OR OBSERVATION STAY |
OBSERVATION (PLACE OF SERVICE 22)
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ALL OBSERVATION ADMISSIONS REQUIRE AUTHORIZATION |
OUTPATIENT HOSPITAL (PLACE OF SERVICE 22)
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HYPERBARIC TREATMENT |
AUTHORIZATION REQUIRED |
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RADIOLOGY SERVICES |
DESERT RADIOLOGISTS IS THE CULINARY HEALTH FUND'S EXCLUSIVE RADIOLOGY SERVICES PROVIDER. SERVICES PERFORMED AT DESERT RADIOLOGISTS DO NOT REQUIRE AUTHORIZATION WITH THE EXCEPTION OF PET SCANS. |
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For Radiology Services not performed at Desert Radiology authorization is required for: CT/CTA, Discography, Fetal Biophysical Profiles, MRI/MRA, PET Scans |
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SLEEP STUDIES |
NOCTURNA IS THE CULINARY HEALTH FUND'S EXCLUSIVE SLEEP STUDY PROVIDER. Requires authorization and must be ordered by a Cardiologist, ENT, Neurologist, Pulmonologist or Culinary Health Center - Primary Care. |
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SURGERY & INVASIVE DIAGNOSTIC PROCEDURES |
AUTHORIZATION REQUIRED (Exception: Colonoscopy and EGD procedures do not require prior authorization.) |
AMBULATORY SURGERY CENTER (PLACE OF SERVICE 24)
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"AUTHORIZATION REQUIRED (Exception: Colonoscopy and EGD procedures do not require prior authorization.) |
DIALYSIS CENTER (PLACE OF SERVICE 65)
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AUTHORIZATION NOT REQUIRED FOR CONTRACTED FACILITIES |
INDEPENDENT LABORATORY (PLACE OF SERVICE 81)
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CLINICAL PATHOLOGY LABORATORIES IS THE CULINARY HEALTH FUND'S EXCLUSIVE LABORATORY PROVIDER AND MUST BE USED FOR ALL OUTPATIENT LABORATORY SERVICES |
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ALL GENETIC TESTING |
AUTHORIZATION REQUIRED |
BEHAVIORAL HEALTH SERVICES (PLACE OF SERVICE 51, 52, 53, 54, 55, 56, 57)
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INPATIENT & OUTPATIENT BEHAVIORAL HEALTH SERVICES |
All behavioral health services require authorization through Harmony Healthcare 702-251-8000 |
TRANSPLANT SERVICES
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AUTHORIZATION IS REQUIRED FOR ALL TRANSPLANT SERVICES INCLUDING CONSULTS |
The table is only a general guideline to Culinary Health Fund's 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 Customer Service at 702-733-9938.
CULINARY HEALTH FUND EXCLUSIVE PROVIDERS
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CARDIOLOGY SERVICES - HEART CARE IPA |
Heart Center of Nevada: 702-433-0022 |
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Nevada Heart & Vascular Center: 702-227-3422 |
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DURABLE MEDICAL EQUIPMENT |
Adapt Health: 702-382-4940 |
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Aveanna Healthcare: 866-883-1188 |
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Everything Medical: 702-366-1111 |
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Gabel Distributors: 702-489-2288 |
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Preferred Homecare: 702-951-6900 |
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LABORATORY SERVICES |
Clinical Pathology Laboratories: 702-795-4900 |
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LABORATORY SERVICES- GENETIC TESTING |
Ambry Genetics: 866-262-7943 (BRCA and other select tests) |
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Sequenom Laboratories: 877-821-7266 (MaterniT 21 Plus & HerediT) |
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PROSTHETIC AND ORTHOTIC APPLIANCES |
Brace It: 702-478-5848 |
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Precision Orthotics & Prosthetics: 702-243-7671 |
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Prosthetic Centers of Excellence: 702-384-1410 |
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RADIOLOGY SERVICES |
Desert Radiologists: 702-387-6900 |
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SLEEP STUDIES |
Nocturna: 702-896-7378 |