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Get Nhpri Prior Authorization Forms

N SHOULD BE MAILED TO: Neighborhood Health Plan of Rhode Island ATTN: CLAIMS QUALITY AND AUDIT 299 Promenade Street Providence, RI 02908 Check the box below that applies to this request - see reference grid below for assistance: Adjustment Request: *Administrative Appeal: Have you included the following: 1. An appeal letter on office letterhead: 2. A completed appeals request form: 3. A hard copy of the claim: 4. All supportive documentation: *If all four boxes are no.

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