Neighborhood Health Providers

CLAIM

PROCEDURES

Phone inquiries about claims:

800-558-7970

Mail Claims to within 90 days of service to: Neighborhood Health Providers

P.O. Box 6008

Hauppauge, NY 11788

Fax Claims or Referral forms to:

888-892-6130

For Neighborhood Health Providers MEMBER ELIGIBILITY ≠ CALL

800-558-7970

NHP

UTILIZATION MANAGEMENT

PROCEDURES

UM Phone: 800-765-3805

UM Fax: 800-338-4195

Send UM Appeals ONLY to:    NHP

                                                        4944 Parkway Plaza Blvd

                                                         Suite 110

                                                         Charlotte, NC 28217

Elective Admissions

Call UM at least 7 days before elective admit

Emergency Admissions

Call UM within 24 hours business days of admit

Maternity Admissions

Call UM within 2 business days of admit

Ambulatory Surgery

Call UM at least 72 hours before elective surgery

(Potentially Cosmetic only) others do not call, no authorization required.

Behavioral Health Elective Inpatient / Outpatient Visit / ER

Pre-certification required

Call Beacon Behavioral Health at 866-969-2661

Dental Services

Members self refer to Healthplex Providers

Call 800-468-9868

Home Health Care / Infusion

Pre-certification required ≠ Call UM

DME, Prosthetics, Orthotics

Pre-certification required for all items with a cost greater than $250 ≠ Call UM

Speech Therapy

First visit does not require pre-authorization. Continuing speech therapy requires pre-certification, call UM

Well Vision Care

Members self refer to Davis Vision Providers

Call 1-800-999-5431

Referral to participating Specialists

Use Referral Form ≠ Mail Referral Form NHP

P.O. Box 6008; Hauppauge, NY 11788 OR

Fax Referral Form to 888-892-6130

Dental Services

Members self refer to Healthplex Providers

Call 800-468-9868