Prior Authorization

Prior authorization is necessary to ensure benefit payment.

You may prescribe a health care service, treatment, equipment or medication to your patient which requires prior authorization. You may submit a prior authorization request through our online provider center or complete a Prior Authorization Form (PDF) or a Pharmacy Prior Authorization Request Form (PDF)

Special authorization requests:

  • ABA providers should submit this form for Applied Behavioral Analysis (ABA) therapy authorization requests.
  • Complete this form for Behavioral Health Outpatient Treatment authorization requests.
  • Submit an Oncology Step Therapy Exception form for members with stage 3 or stage 4 cancer. Oncology requests should be submitted under urgent status through phone, fax or web portal.

The goal is to ensure health plan members receive the most appropriate, medically necessary care. All requests are reviewed by a licensed physician or under the supervision of one. Furthermore, only a physician may deny a request.

You may file an appeal if coverage is denied.

To appeal a decision, mail a written request to:

Sierra Health and Life, Member Services
P.O. Box 15645
Las Vegas, NV 89114-5645

Sierra Health and Life providers must file an appeal within 180 days.

If you have any questions, call 1-800-745-7065 or sign in to the online provider center.