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  • Prior Authorization Request Form - New Hampshire Healthy Families

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NEW HAMPSHIRE HEALTHY FAMILIES MEDICATION PRIOR AUTHORIZATION REQUEST FORM Please DO NOT USE this form for Specialty and/or Biopharmaceutical Requests.

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NH Medicaid (Medical Assistance) is a federal and state funded health care program that serves a wide range of individuals and families who meet certain eligibility requirements.

There are three New Hampshire Medicaid Health Plans to choose from: AmeriHealth Caritas New Hampshire. NH Healthy Families. WellSense Health Plan.

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

NH Healthy Families provides the same benefits as Medicaid, plus more. In this section, you can learn about the health benefits, pharmacy services and value added services NH Healthy Families offers. Need help understanding these benefits and services? Call us at 1-866-769-3085 (TDD/TTY 1-855-742-0123).

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

To participate in NH Medicaid (Medical Assistance), federal law requires the Department to cover certain groups of individuals. Low-income families, qualified pregnant women and children, and individuals receiving Supplemental Security Income (SSI) are examples of mandatory eligibility groups.

This prior authorization list is for your general information only. Please call NH Healthy Families Member Services for the most up to date information at 1-866-769-3085.

Contact the DHHS Customer Service Center toll-free at 1-844-ASK-DHHS (1-844-275-3447) (TDD Relay Access: 1-800-735-2964), Monday through Friday, 8:00 a.m. to 4:00 p.m. ET. Contact your local District Office. Visit Related Resources for additional eligibility information.

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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