Food Service II Plan Prior Authorization

The following table is only a general guideline to UNITE HERE HEALTH Hospitality Plan 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 might not be liable. Verification of benefits and eligibility should be obtained by calling UNITE HERE HEALTH at 855-405-3863.

Prior authorization rules
by place of service


For Prior Authorization, please contact NEVADA HEALTH SOLUTIONS:
Phone: (855) 487-0353 toll free
Fax: (866) 201-5601
https://www.nevadahealthsolutions.org

Call UNITE HERE HEALTH at (855) 405-FUND (3868) to verify benefits and eligibility.

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 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*
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-FUND (3863).

Notification only:

Inpatient and Residential Behavioral Health services
Inpatient and Residential Behavioral Health services

* This is not covered under every UNITE HERE HEALTH Plan. Call UNITE HERE HEALTH customer service at
(855) 405-FUND (3863) to check on benefits.