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  • General Auth Request Form - Neighborhood Health Plan Of Rhode ...

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General Prior Authorization Form Page 1 of 1 Please return completed form to the Utilization Management Department at (401)459-6023. Please refer to Neighborhood s Clinical Medical Policy which is.

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If you think more information or an additional form may be needed, please check the issuer's website before faxing or mailing your request. Please fax form to Superior HealthPlan at 1-866-399-0929.

Should you need to submit claims please submit electronically or mail to our claims address PO Box 28259 Providence, RI 02908.

The PA attachment allows a provider to document the clinical information used to determine whether or not the standards of medical necessity are met for the requested service(s).

Contact Us PLAN CONTACT INFORMATIONAddressNH Healthy Families 2 Executive Park Drive Bedford, NH 03110Member and Provider Services Phone Number1-866-769-3085 (TDD/TTY: 1-855-742-0123)Member Inquiries1-866-769-3085 (TDD/TTY: 1-855-742-0123)Media InquiriesCommunications Department Office: 1-866-769-3085

Non-participating providers must submit Prior Authorization for all services. For non-participating providers, Join Our Network.

Please contact TurningPoint phone at 1-855- 909-6222 or by fax at 1-603-836-8903.

The requested clinical should be faxed to Medical Management, using the appropriate fax number for the service for which authorization is requested. Medicaid Prior Authorization Fax Numbers: Physical Health: 1-800-690-7030. Behavioral Health: 866-570-7517.

Neighborhood is one of only two Medicaid Health Plans out of 185 across the country to achieve this rating in 2021 and the only Medicaid Health Plan to do so in Rhode Island.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232