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How do I request an external review?

You should send your request for an external review to the Governor’s Office for Consumer Health Assistance (“Governor’s Office”) within four months from when your insurer sent you the final decision.[4] The Governor’s Office will then assign an external review organization to review your claim.[5]

Information. You can find a copy of the external review request form here. You should include the following information with your request:

  • Name of applicant;
  • Name, address, and telephone number of the insured person;
  • Name of the patient (if different from the applicant);
  • Name, address, and telephone number of the health insurer;
  • Insurance identification number, claim or reference number;
  • Employer name and telephone number;
  • Name and address of your treating physician or health care provider;
  • The name and telephone number of the contact person at your provider’s office;
  • Your medical record number;
  • The reason for denial;
  • Brief description of the claim;
  • Description of the health care service or treatment in dispute; and
  • The health care provider certification form on page 6 of the external review packet (this form only needs to be completed if you are requesting an expedited review).[6]

Supporting documents. You should include the following documents with your request:

  • A copy of your insurance card or other evidence showing coverage;
  • A copy of the determination letter from your health insurer;
  • A copy of your insurance policy; and
  • Any new information or documentation not included with your request for an internal appeal.[7]

Submitting a standard external review. If you are requesting a standard external review, you should submit your request to the following address:

Office for Consumer Health Assistance
555 East Washington #4800
Las Vegas, NV 89101[8]

Submitting an expedited review. If you are requesting an expedited external review, you should contact the Office for Consumer Health Assistance at (702) 486-3587 or (888) 333-1597 for instructions on the fastest way to submit your request and supporting documentation.[9]