Teamsters Local 631 Prior Authorization

The following table is only a general guideline to Teamsters Local 631 Security Fund 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 BeneSys at 877-304-6702.

Prior Authorization Rules
by place of service

For Prior Authorization, please contact NEVADA HEALTH SOLUTIONS:
Telephone: 702-216-1653
Fax: 702-691-5614
https://www.nevadahealthsolutions.org

Call BeneSys at 877-304-6702 to verify benefits and eligibility.

Prior authorization is required for:

In Office or Freestanding Facility
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
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
Sleep Studies
Autism Treatment, including Applied Behavioral Analysis (ABA) Therapy
Durable Medical Equipment items over $500 (whether rented or purchased)
All clinical trials
Dispatch Health
Wigs (cranial or scalp prosthesis) up to $300 every 2 years for baldness related to chemotherapy; radiation Treatment, severe burns with resulting permanent hair loss.

This table is only a general guideline to Teamsters Local 631 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 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 BeneSys at 877-304-6702.