Prior Authorization is an application to obtain Neighborhood consent before starting treatment. The review and decision-making process is based on medical necessity. We will examine all of the provided information, including any medical records. If we require more information, we may contact your provider.
How To Be a Member?
If you want to become a member, go through this link- https://www.nhpri.org/become-a-member/
What activities are subject to Prior Authorization?
To find out if a service requires Prior Authorization, call Member Services at 1-844-812-6896 (TTY 711), Monday through Friday from 8 a.m. through 8 p.m., and Saturday from 8 a.m. through 12 p.m. You can also check the Member Handbook to see if a service or code is covered (Evidence of Coverage).
Please keep in mind that emergency care, urgent care, family planning, and dialysis, whether in or out of network, are not subject to prior authorization.
Prior Authorization Forms
If you want to send the request, go through this link-
New Century Health Workflow Request
To go to their website, go through this Portal: https://my.newcenturyhealth.com
You can also contact them:
- Fax: 877-624-8602
- Phone: 888-999-7713
There are some general forms:
- Quantity Limit Exception Form
- Exception Criteria Form– This is the form for using drugs that require Prior Authorization, Quantity Limit, or are Non-Formulary
- Go through this link for using drugs that require Step Therapy
- Long-Acting Opioid Prior Authorization Form
- Short Acting Opioid Prior Authorization Form
If you want drug-specific request forms go through these links:
- Botox Request Form
- Hemophilia Case Review Form
- Hemophilia Prior Authorization Form
- Hepatitis C Prior Authorization Form
- Hetlioz Commercial PA Form
- Kymriah Request Form
- Synagis Request Form
- Yescarta Request Form
If you want general medical authorization request forms go through these links:
Neighborhood Health Plan Of Rhode Island Location
They are located at, 910 Douglas Pike
Smithfield, RI 02917
Neighborhood Health Plan Of Rhode Island Web Address
- Facebook- https://www.facebook.com/NeighborhoodRI
- Twitter- https://twitter.com/NHPRIHealth
- Linkedin- https://www.linkedin.com/company/nhpri
- Youtube- https://www.youtube.com/channel/UCnVXrksslL0slbvFqLO2mbA?guided_help_flow=3
- Instagram- https://www.instagram.com/nhprihealth/
Neighborhood Health Plan Of Rhode Island Careers
If you want to build up your career and want to improve your skill, go through this link- https://www.nhpri.org/careers/
How does one go about obtaining Prior Authorization?
A decision on standard requests is made within 14 calendar days of the date the proposal was obtained. The decision will be communicated in writing to the member and provider.
A decision is rendered for expedited requests within 72 hours of the requested date. The decision will be communicated to the member and provider by the Neighborhood. The medical necessity standards used by Neighborhood are available upon request and are based on InterQual and Clinical Medical Policies. Here, you can find the Clinical Medical Policies.
Prior approval does not guarantee payment. Before providing services, all providers should check their eligibility.
In conclusion, the Neighborhood Health Plan Of Rhode Island Prior Authorization Form is an essential document for any patient who wishes to receive medical care from an out-of-network provider. The form helps ensure that the healthcare provider can meet the patient’s needs in an affordable and timely manner. With the correct completion of the prior authorization form, patients can rest assured that they have taken the necessary steps to receive the highest healthcare quality.
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