Nevada: Start Here
Beginner guide for Nevada—Nevada Health Link, OCHA/IRO external review, AB 463 PA & grievance deadlines.
Read guideState playbook
Nevada
State insurers, legislation, and appeal resources for patients and advocates in Nevada.
4 guides
Nevada Prior Authorization Law
AB 463 / NRS 687B.225—2 business day/7-day PA cap, deemed approved, biomarker & emergency exemptions.
Read guideNevada Health Insurance Appeals and Grievances
180-day filing common—30-day MCO complaint, 72-hour expedited, exhaustion path to NRS 695G.251.
Read guideNevada External Review (OCHA / IRO)
Binding on carrier—4-month filing with OCHA, 15-day standard, 72-hour expedited, NRS 695G.241–310.
Read guidePrior auth & internal appeals
Match the plan on the member ID card. Use the denial letter for where to file appeals.
- Health Plan of Nevada
- Anthem / Community Care (Nevada)
- SilverSummit (Ambetter)
- Hometown Health
- Molina Healthcare (Nevada)
- Nevada Health Link
- Nevada Medicaid (DHCFP)
External appeals
After internal appeal, for eligible Nevada fully insured plans only.
- OCHA — external review
- Medicaid — state fair hearing