Hospitality 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

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 (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