Prior Authorization (PA) Overview

The Division of Health Care Financing and Policy (DHCFP) and the Gainwell Technologies Provider Training team conducted training sessions for all provider types regarding prior authorizations. This targeted training includes: basics of a prior authorization, location of required forms, navigation of the PA submission process, after submission, and location of valuable resources on the Nevada Medicaid website. Due to HIPAA compliance, this training will not utilize any PHI. 00:00 – Introduction 00:23 - Objectives 1:06 – What is prior authorization? 2:33 – Navigating Nevada Medicaid website – forms, links 9:56 – Provider training page 12:40 – Initiating a prior authorization 20:04 – Confirming authorization 21:10 – Search options 22:25 – Status 25:30 – After submitting the request 27:42 – Adverse determination 29:16 – Peer-to-peer review 31:06 – Reconsideration/appeal 32:49 – Continued stay request 33:58 – Additional information about reconsideration 34:55 – Resources 36:48 - End