Hospitality Plan 185 prior authorization
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
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
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 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-FUND (3863).
Notification only
Inpatient and Residential Behavioral Health services
|