MedicaidPrior AuthHigh impact
Attention Psychiatric Residential Treatment Facility (PRTF) Providers: Prior Authorization Request Form Updated
Nevada Medicaid·NV · Psychiatry·Prior Authorization
Effective date
Jun 25, 2026
We identified it
Jun 26, 2026
Summary
Nevada Medicaid has merged two prior authorization forms for Psychiatric Residential Treatment Facilities (PRTFs). The PRTF Concurrent Review form (FA-13) and PRTF Prior Authorization Request form (FA-15) are now combined into a single updated FA-15 form dated 06/25/2026. Providers must immediately discontinue use of the old forms and submit all PRTF prior authorization requests using only the new FA-15 form, or requests will be returned for resubmission.
Action Required
Immediately: Billing team and prior authorization staff must discontinue use of the previous version of Form FA-15 and Form FA-13. Update all internal documentation, templates, and workflow processes to reflect that only the updated FA-15 form (dated 06/25/2026) should be used for ALL PRTF prior authorization requests, including concurrent reviews. Replace old form versions in billing software, provider portals, and shared drives. Notify all clinical and administrative staff submitting PRTF requests of the change. Consequence: Any requests submitted on previous form versions will be returned and require resubmission, causing delays in authorization and potential claim denials.