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 (3863) to verify benefits and eligibility.
Prior authorization is required for:
In-Office or Freestanding Facilities
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All hematology/oncology services
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Hyperbaric treatment
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Orthotic & prosthetic appliances over $500
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Radiology services: CT/CTA, Discography, MRI/MRA, PET Scans
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Varicose veins
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TMJ procedures orthognathic surgery
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Physical, speech and occupational therapy
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Sleep Studies
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End stage renal disease treatment facility
Home health and home infusion services
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All skilled services in a home setting
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Inpatient
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All inpatient admissions (except 2 day Vaginal Deliveries and 4 day Cesarean Sections)
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All admissions to skilled nursing, acute rehabilitation, and long term acute care facilities
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Outpatient hospital
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Hyperbaric treatment
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Radiology services: CT/CTA, Discography, MRI/MRA, PET Scans
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Hematology/oncology services
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Dialysis
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Physical, speech, and occupational therapies
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Sleep studies
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All surgery & invasive diagnostic procedures performed in surgery area (except colonoscopy/sigmoidoscopy)
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Ambulatory surgery center
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All outpatient surgery or procedures (except colonoscopy/sigmoidoscopy)
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Additional services
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All transplant services (including consults)
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All genetic testing
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All air ambulance transports
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Medical foods for inborn errors of metabolism
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ABA Therapy*
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Durable Medical Equipment items over $500 (whether rented or purchased)
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All clinical trials
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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
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Inpatient and Residential Behavioral Health services
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*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.
