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  • Nh Amerihealth Caritas Standardized Prior Authorization Request Form 2021

Get Nh Amerihealth Caritas Standardized Prior Authorization Request Form 2021-2025

Standardized Prior Authorization Request Form COMPLETE ALL INFORMATION ON THE STANDARDIZED PRIOR AUTHORIZATION REQUEST FORM. A COPY OF ALL SUPPORTING INFORMATION IS REQUIRED. LACK OF INFORMATION MAY.

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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.

Timely claims filing Original submission: no more than 120 days from date of service. Rejected claims: no more than 120 days from date of service. Denied claims: within 365 days of date of service. Third-party liability (TPL) claims: within 60 days of date of primary insurer's explanation of benefits (EOB).

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.

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

As an AmeriHealth Caritas New Hampshire member, you keep all of your core Medicaid benefits. What's more, you can enjoy extra benefits, too. We make care the heart of our work.

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

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.

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

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
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