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  • Pet Ct Prior Authorization Form - Nhp.org

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PET PET CT PRIOR AUTHORIZATION FORM SECTION 1. MEMBER DEMOGRAPHICS Patient Name (First, Last): DOB: Health Plan: Member ID #: Group #: SECTION 2. ORDERING PROVIDER INFORMATION Physician Name (First,.

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NH Healthy Families provides the same benefits as Medicaid, plus more.

Please fill out the below form or contact us at 1-866-769-3085. Your inquiry will be reviewed. A NH Healthy Families representative may contact you regarding your inquiry.

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.

If providers have questions after checking the MMIS online portal, please contact the state's Medicaid Provider Service Center at 1-866-291-1674.

Prior Authorization requests will be reviewed and a decision rendered within 24 hours. 5. How does one check the status of a PA? Providers may contact Pharmacy Services at (877) 250-5227 or NH Healthy Families at (866) 769-3085.

Non-participating providers must submit Prior Authorization for all services. For non-participating providers, Join Our Network. Urine Drug Screens rendered by MAT (Medication Assisted Treatment) providers require notification only. Prior auth is not required.

Please contact TurningPoint phone at 1-855- 909-6222 or by fax at 1-603-836-8903. Dental services are not administered by NH Healthy Families. Non-participating providers must submit Prior Authorization for all services.

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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