Preparing for surgery
Surgery can be stressful for your patients. They might not know what to do to prepare for it. We’ll help them get ready for their surgery and plan for their return home.
All surgeries require prior authorization from Nevada Health Solutions (NHS). You should plan ahead and submit prior authorization requests as early as possible before surgery.
For prior authorization:
Connect is our web-based tool that accepts prior authorization requests 24 hours a day, 7 days a week.
You can use Connect to:
- Submit a prior authorization request at any time
- Check the status of a prior authorization request
- Get immediate confirmation that we’ve received your request
What to include
When requesting prior authorization, be sure to submit all pertinent clinical information, including:
- Medical records
- Test results
- and other related documents
The average turn-around time for prior authorization is less than 3 days, when all clinical information is included in the request.
View the Culinary Health Fund Prior authorization rules by place of service.
Q: My patient needs surgery scheduled beyond the eligibility period shown on the website. How can I verify a patient’s future eligibility?
A: We update our participants’ eligibility in 2-month periods. Please schedule the surgery and then re-check your patient’s eligibility closer to the surgery date.
Copays for surgery
|Place of surgery||Copay||Coinsurance|
|Ambulatory surgery center||$150||None|
|Hospital — outpatient||$250||None|
|Hospital — inpatient|| $250 for in-patient stay|
$0 for surgery/anesthesia
Nevada Health Solutions
Our Nevada Health Solutions care team is a great resource for you and your patients. NHS’ Personalized Surgical Management (PSM) program will help ensure that your patients are fully prepared for their surgery. The goal of the PSM program is to help improve surgical outcomes. The PSM program offers your patients:
- Pre-habilitation in the home prior to surgery
- A home safety evaluation
- Education on what to expect after surgery
The NHS team will also help during your patient’s recovery. If your patients have to stay in the hospital for one or more nights, NHS will work with you and your patients to make sure both of your needs are met. An NHS care team member may visit your patients after their surgery to see how they’re doing.
Loss of time
If your patients need to miss work after their surgery, they have a Loss of Time (LOT) benefit which pays them for their missed time at work. The benefit is limited to a maximum of 13 weeks. To get the LOT benefit, an LOT formDownload PDF must be completed by you, your patients, and their human resource department.
How do my patients get their LOT benefit?
- Your patients should print an LOT formDownload PDF or pick one up at our Customer Service Office.
- Your patients need to fill out their part of the LOT form.
- Part 1 of the form needs to be completed by you, their provider. Per our preferred provider contract, please do not charge your Culinary patients to fill out this form.
- Part 2 must be completed by your patients’ human resources department.
Once all sections are complete, the form needs to be sent to our Customer Service Office. The completed form can be turned in by either you, your patient, or their employer.
The LOT form can be submitted by mail, fax, or in person to: