Prior Authorization in Nevada
Soft Home Global provides authorizations submitted ahead of the date of service and chased to a decision for Nevada practices and billing companies at $1,900 per seat per month. Full time, worked during Nevada business hours, inside your own system.
What is specific to Nevada
Nevada Medicaid moved to statewide managed care in January 2026, extending contracted plans into rural and frontier counties that were previously fee-for-service, so plan enrollment now drives payment almost everywhere.
Nevada’s Medicaid program is Nevada Medicaid. Practices with a meaningful Nevada Medicaid mix usually need it worked as its own queue rather than mixed into commercial follow-up, because the submission path, the timely filing window and the appeal route are all different.
Medicare here is adjudicated by Noridian Healthcare Solutions, jurisdiction JE — shared with California, but not with Arizona (JF), Idaho (JF), Oregon (JF) or Utah (JF). CMS publishes the jurisdictions; checked September 2026.
What a prior authorization seat does in Nevada
Submitted before the date of service and chased through the payer's decision window.
An authorisation found after the visit is a write-off, not a denial to appeal. In Nevada the work is submitting ahead of scheduling and chasing the decision, against a payment clock that starts only once a clean claim lands.
- Authorizations submitted ahead of scheduling, not after
- Status chased rather than waited on
- Peer-to-peer reviews scheduled when required
- Clinical documentation gathered before submission
- Expiring authorizations flagged before they lapse
- Worked during Nevada business hours, not queued overnight
For the statute behind all of this — Nevada’s prompt-pay deadline, its Medicaid filing limit, and the wrinkle that catches people out here — see the Nevada billing page.
Nevada Medicaid, in practice
Managed care, now statewide: five MCOs — Anthem Blue Cross and Blue Shield Healthcare Solutions, CareSource, Health Plan of Nevada, Molina Healthcare of Nevada, and SilverSummit Healthplan — with only a residual fee-for-service population. Source: medicaid.nv.gov
On January 1, 2026 Nevada extended Medicaid managed care into the rural counties for the first time, moving roughly 75,000 rural residents out of fee-for-service. Rural members can only choose between two of the five plans: 'Rural Nevadans can pick from two managed care health plans starting January 1, 2026: CareSource and SilverSummit.' A rural Nevada practice that billed Nevada Medicaid FFS directly must now be contracted with those two MCOs. Source: medicaid.nv.gov
For authorisations it decides who you ask. A carve-out means the rules, the portal and the turnaround belong to a different administrator from the one handling the rest of the member’s care, and an authorisation obtained from the wrong one is not an authorisation.
Working Nevada hours
Nevada runs on Pacific time, 13 hours behind our floor in Rawalpindi. To be at a desk for your nine to five, the shift here runs 10pm to 6am, and 9pm to 5am once the clocks go forward. Pakistan does not observe daylight saving, so the shift moves on this side rather than yours.
One wrinkle worth naming: West Wendover runs on Mountain time. If your practice sits on that side of the line, say so on the call and the shift is set to your clock rather than the one most of the state keeps.
That is the part that decides whether follow-up happens at all: a payer’s phone lines are open on Nevada hours and nobody else’s.
What it costs in Nevada
$1,900
Per seat, per month, in US dollars — $22,800 a year for one full-time person, forty hours a week, on Nevada hours. No annual contract, no percentage of collections, no setup fee and no software to buy. Seat prices across all roles in Nevada run $1,500 to $2,500; the full list is published.
That is the entire invoice. Run your own figures against a percentage vendor or a hire rather than take ours.
Getting started in Nevada
About a week from a signed agreement to a person working your queue, and that week of training is not billed on top. The week, step by step, and what is signed before anyone has access.
If working with staff outside the United States is new to your practice, see how a medical billing company structures that seat and why offshore medical billing does not have to mean losing visibility into the work.
Questions
Do you work with Nevada practices?
Yes. Nevada accounts are worked during Nevada office hours rather than queued overnight, because a payer's phone lines are open then and at no other time.
What is different about Nevada?
Nevada Medicaid moved to statewide managed care in January 2026, extending contracted plans into rural and frontier counties that were previously fee-for-service, so plan enrollment now drives payment almost everywhere.
Which Medicare Administrative Contractor covers Nevada?
Noridian Healthcare Solutions, the A/B MAC for jurisdiction JE. Medicare Advantage and commercial plans run their own authorizations; for traditional Medicare, the hospital outpatient services on CMS’s prior authorization list are reviewed by this MAC.
When does a Nevada payer have to pay a clean claim?
21 days for electronic clean claims, 30 days for non-electronic — effective January 1, 2026 under AB52 (83rd Session, 2025), which shortened the prior uniform 30-day rule. Approved claims must be paid within that same window. The authorization gets the service approved; this is the deadline for paying the claim that follows it, once that claim is clean.
How fast must Nevada Medicaid decide a prior authorization?
Under the federal CMS-0057-F rule, from 1 January 2026: 72 hours for an expedited request and seven calendar days for a standard one, for Medicaid fee-for-service and Medicaid managed care plans alike, counted in calendar time whether the request went by portal, fax or phone. The calculator at softhomeglobal.com/prior-auth-deadline works out the date.
How much does prior authorization cost in Nevada?
$1,900 per seat per month — $22,800 a year for a full-time person, forty hours a week. Every seat price is published at softhomeglobal.com/pricing.
What hours will somebody actually be working our Nevada queue?
Nevada is on Pacific time, 13 hours behind Rawalpindi. The shift here runs 10pm to 6am so your seat is at a desk for your full working day, shifting to 9pm to 5am while daylight saving is in force — Pakistan does not observe it, so the change happens on our side.
Do you handle Nevada Medicaid as well as commercial payers?
Yes, and as its own queue rather than mixed into commercial follow-up. Nevada Medicaid has its own submission path, its own filing window and its own appeal route, and working it in the same worklist as commercial claims is how the deadlines get missed.
Is this a percentage of what you collect?
No — a flat monthly rate per seat, published at softhomeglobal.com/pricing. A percentage bills you most in your best month and points the vendor at the easy accounts.
More for Nevada
Next step
One seat on your Nevada work
Twenty minutes on a call is enough to tell whether this fits. If it does not, I will say so.
Or write to ops@softhomeglobal.com