State Hearing and External Review

External Review Process

If you are unhappy with a CareSource decision made in response to an internal appeal you filed, you may request an external review. In most cases, you must go through all the steps in the internal appeal process before you can ask for an external review.

You or your authorized representative may request an external review of your final adverse determination notice by contacting the State of Nevada Office for Consumer Health Assistance and using the form below. You must ask for the external review within 4 months of the date of the notice of the final adverse determination notice issued by us. 

For questions about your rights, this notice, or for further assistance you may contact:  

State of Nevada Office for Consumer Health Assistance  
Phone:702-486-3587 or toll free 888-333-1597  
Email: CHA@govcha.nv.gov 

You may submit your request to Nevada Office for Consumer Health Assistance by mail using an External Review request form.

What Happens Next?

Once the Office for Consumer Health Assistance receives your request for a standard External Review or Expedited External Review, the Office for Consumer Health Assistance will send the request to CareSource to determine if your request meets the criteria for an External Review.  If your request meets the criteria for an External Review, then your request will be assigned to an Independent Review Organization who will make a decision to either uphold or overturn the Final Adverse Benefit Determination.   

If you need help reading this information, please call us. We can read the information aloud for you, in English or in your primary language. We also can help you if you are visually or hearing impaired. If you ask, we can provide language services to help you file a complaint or appeal and to notify you about your complaint or appeal. This is a free service.