The purpose of these guides (below, by line of business) is to inform you of services that require prior authorization. Search functionality is limited to codes that are not in ranges. If you cannot find a code try searching the first 3 characters of the code to bring you to ranges that may include the code you are searching for.
- Neighborhood ACCESS / RIte Care
- Neighborhood TRUST / Rhody Health Partners (RHP) and Rhody Health Partners Expansion (EXP)
- Neighborhood Exchange Plans
- Neighborhood INTEGRITY (Medicare-Medicaid Plan)
If you do not find a specific service listed on these guides, it may be that the service is a non-covered benefit. If you need information related to covered services, please refer to our Billing Guidelines and Coverage Summaries or call Neighborhood Member Services at 1-800-459-6019.
Access Prior Authorization Forms here. Forms can be completed online or submitted to the 24/7 fax line at 401-459-6023.If you have any questions about the authorization process, please call Utilization Management at 401-459-6060.
Neighborhood has partnered with eviCore healthcare for prior authorization of outpatient elective CT, MR, PET, CT Cardiac, MR Cardiac, PET Cardiac, Nuclear Cardiology and 3D Rendering Procedures.
Please note: Neighborhood and eviCore will accept authorizations from either the ordering or rendering provider prior to the service being rendered.
For more information visit eviCore.