Prior Authorization

Prior authorization is necessary to ensure benefit payment

A health plan member’s provider may prescribe a health care service, treatment, equipment or medication which requires review and approval. This process is called prior authorization, and the goal is to ensure health plan members receive the most appropriate, medically necessary care.

All requests requiring a medical or clinical decision are reviewed by a licensed physician or under the supervision of one. Furthermore, only a physician may deny a request. To learn more, health plan members review their plan documents.

A member or his/her provider may file an appeal if coverage is denied. To appeal a decision, mail a written request within 180 days from the date of the denial to: Sierra Health and Life, Member Services, P.O. Box 15645, Las Vegas, NV 89114-5645

For Applied Behavioral Analysis (ABA) therapy authorization requests, ABA providers should submit this form.