What is prior authorization?
Prior authorization (PA) means the health plan must approve certain care before it will cover it. Providers often submit requests for you, but you still have rights if PA is denied or delayed.
Overview: Prior authorizations. Nevada-only details below.
Confirm plan type: Nevada: Start Here.
Nevada PA rules
Nevada's main PA reform is Assembly Bill 463 (2025), which amended NRS 687B.225 effective January 1, 2026 for most fully insured health carriers.
Decision deadlines (NRS 687B.225, as amended)
- Standard: respond within 2 business days after receiving the request, or within the CAQH Prior Authorization operating rules period if longer—but never more than 7 calendar days after receipt
- If the carrier violates these timeframes for a particular request, the PA is deemed approved
- Carriers must file PA procedures with the Commissioner and may not discriminate among licensed provider types
Services that cannot require PA (AB 463)
- USPSTF "A" or "B" preventive services and certain immunizations
- Pediatric hospice care
- Outpatient substance use disorder services
- Neonatal abstinence syndrome treatment
- Blood glucose test strips for people with diabetes
Managed care & other statutes
- Emergency services: no PA required (NRS 695G.170)
- Biomarker testing PA: often 2 business days, or 24 hours when a practitioner certifies exigent circumstances (NRS 695G.1703)
- Telehealth: plans generally cannot require PA for telehealth if PA is not required for the same in-person service (NRS 695G.164, 695B.1904)
Older contracts still reference a 20-day response under prior law; AB 463 superseded that baseline for carriers subject to the amendment.
Where to look up PA rules
Carriers must publish PA criteria. Use your denial letter first, then your plan's provider or member portal.
Carrier links: Nevada prior auth & internal appeals links.
Medicaid
Nevada Medicaid managed care (Health Plan of Nevada, Anthem, Molina, SilverSummit, and others) follows MCO prior authorization under federal Medicaid rules, with AB 463 also setting 2 business day / 7 calendar day response standards for Medicaid PA requests. Denials use MCO appeal and DHCFP fair hearing paths—see Nevada internal appeals.
If PA is denied
Request the clinical rationale and file an internal appeal within the deadline on your notice (often 180 days on Marketplace plans).
Next: Nevada internal appeals.
Urgent care
Mark the request urgentwhen waiting for a standard decision would seriously jeopardize life, health, or ability to regain maximum function. Under NRS 687B.225 (as amended), carriers must respond within the urgent timeframe in your plan's operating rules, capped at 7 calendar days.
For biomarker and certain clinical PA appeals, exigent cases may require a response within 24 hours (NRS 695G.1703).