Health Plan of Nevada (HPN) Prior Authorization

Health Plan of Nevada (HPN) prior authorization rules are often service-specific rather than universal, so the safest workflow is to confirm the requirement in the payer's provider resources before scheduling or submitting care. The notes below summarize the most actionable provider-side guidance captured in the research set for this payer.

At a glance

• HPN says all routine prior authorization requests for Health Plan of Nevada Inc. and Sierra Health and Life Insurance Company providers must be submitted online through the Online Provider Center. Stat/urgent requests can also be submitted through the Online Provider Center, and may additionally be called or faxed to the UM Department. The online center also supports referral submissions and claim status tracking.
• The cited Utilization Management guide is 2025 and names Health Plan of Nevada Inc. and Sierra Health and Life Insurance Company providers; Medicaid-specific operational requirements may vary by line of business.
• I did not find a single official page listing all prior-auth-required services in a concise searchable format during this pass.

Where to verify prior authorization requirements

• Verification resource 1
• Verification resource 2

How to submit prior authorization requests

• Online Provider Center

• Phone for stat/urgent requests

• Fax for stat/urgent requests

• Submission resource 1

Information commonly required

• Pertinent case-specific clinical information
• Progress notes
• Laboratory results
• Radiology results
• Previous medications
• Relevant medical personal/family history
• Other factors impacting the plan of care

Turnaround notes and caveats

• Routine requests are reviewed within the timeframes required by DOL, CMS, and Nevada Medicaid managed care rules; the cited guide does not give one fixed routine-day number.
• Urgent/expedited requests are to be determined and provider-notified within 72 hours, though HPN says it strives to provide a determination within one calendar day.
• For cancer-related diagnosis requests submitted by phone/fax, the cited guide states they are processed in 24 hours for STAT and 72 hours for routine requests.
• The cited Utilization Management guide is 2025 and names Health Plan of Nevada Inc. and Sierra Health and Life Insurance Company providers; Medicaid-specific operational requirements may vary by line of business.
• I did not find a single official page listing all prior-auth-required services in a concise searchable format during this pass.

Provider resources

• Provider home / contact information (official)
• Online Provider Center (official)
• Submit or Appeal a Claim (official)
• Provider Advocates (official)
• 2025 Provider Summary Guide - Utilization Management (official)
• 2025 Claim Reconsideration Request Form (official)
• 2024 Provider Summary Guide - Claims (official)

Sources