CurrentCulinary Health FundPolicy N/A

COVID-19 elective procedure authorization pause

Culinary Health Fund will not process authorizations for non-essential elective procedures during the COVID-19 pandemic; providers may request authorization for procedures they consider essential. Affects Culinary Health Fund members and their providers in Nevada.

Policy Summary

PayerCulinary Health Fund

PolicyCOVID-19 elective procedure authorization pause

Policy CodePolicy N/A

Change TypeOperational pause (added)

Effective DateMar 16, 2020

Next Review DateN/A

Key ActionIf a provider believes a procedure is essential, submit an authorization request to Nevada Health Solutions with clinical justification.

SourceLink

POLICY UPDATE CHANGES

Authorizations for non-essential, elective procedures will not be processed effective immediately.

authorizations suspendednon-essential elective procedures

exceptions allowedexceptions allowed

continuous reassessmentreassessment

Coverage criteria and scope

Exception to Elective Authorization Pause

Covered when ALL of the following are met

Exception authorization: Provider submits authorization request to Nevada Health Solutions with justification that the procedure is essential and critical to the patient’s health and must be performed now.clinical justification provided

Normal elective procedure authorizations will not be processed unless this condition is met.

Authorizations for non-essential, elective procedures are excluded from processing until further notice. Effective immediately, Culinary Health Fund (via Nevada Health Solutions) will not process prior authorizations for non-essential, elective procedures; this operational pause will be reassessed continually as the COVID-19 pandemic evolves.

What providers must do

Prior Authorization

Policy Summary

PayerCulinary Health Fund

PolicyCOVID-19 elective procedure authorization pause

Policy CodePolicy N/A

Change TypeOperational pause (added)

Effective DateMar 16, 2020

Next Review DateN/A

Key ActionIf a provider believes a procedure is essential, submit an authorization request to Nevada Health Solutions with clinical justification.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Prior authorizations paused for non-essential elective procedures

Effective immediately, the Culinary Health Fund (via Nevada Health Solutions) will not process prior authorizations for non-essential, elective procedures. Do not submit routine elective authorization requests at this time; they will not be reviewed or approved while this pause is in effect.

All prior authorization requests for non-essential elective procedures will not be processed
Requests for routine elective surgeries submitted during the pause risk denial/automatic non-processing

Note

How to request an exception for essential procedures

If you believe a procedure is essential and cannot be safely delayed because it is critical to the patient’s health, notify Nevada Health Solutions and submit the authorization request with supporting clinical documentation explaining urgency and medical necessity.

Include clear clinical rationale and supporting records that explain why delay would harm the patient
Submit the request to Nevada Health Solutions with usual authorization forms plus urgent/exception rationale

Documentation Required

Provider responsibilities and documentation

Providers should discuss risks and benefits of procedural delay with patients and document that discussion in the medical record. Nevada Health Solutions will review exception requests on a case-by-case basis and work with providers to support patients with urgent needs.

Document patient counseling about risks/benefits and reason for proceeding if seeking an exception
Expect case-by-case review; provide timely clinical evidence to facilitate review

Denial Risk

Denial risk for non-essential elective procedure requests

Requests for non-essential elective procedures submitted during this pause will not be processed and are at risk of denial. The pause will be reassessed continuously; providers will be notified when processing resumes.

This action is intended to conserve PPE and preserve hospital capacity during the COVID-19 response
Notification will be sent when the prior authorization pause is lifted

Policy rationale and context

This policy reflects public health guidance to delay elective procedures to preserve healthcare capacity, personal protective equipment, and supplies during the COVID-19 outbreak. Providers should discuss risks and benefits of procedural delay with patients and use CDC and local health district resources for evolving guidance. If a provider believes a procedure is essential — critical to the patient’s health and must be performed now — submit an authorization request to Nevada Health Solutions with clinical justification for consideration.

Key definitions

inv-08: Essential procedure — define as procedure judged by provider to be critical and must be performed now

DefinitionEssential procedure — a procedure judged by the provider to be critical to the health of the patient and that must be performed now.

Who decidesDetermination is made by the treating provider based on clinical judgment.

Action requiredProvider must notify Nevada Health Solutions with an authorization request that includes justification when the procedure is deemed essential.

ContextApplies during the Culinary Health Fund operational pause on non-essential elective authorizations effective March 16, 2020.

ReassessmentPolicy and pause will be continually reassessed as the COVID-19 pandemic evolves; notifications will be sent for changes.