Please return completed form to the Utilization Department at 401-459-6023
Please refer to Neighborhood’s Clinical Medical Policy which is available on our Neighborhood web site, www.nhpri.org for more detailed information about this benefit, authorization requirements, and coverage criteria.
Please remember: An authorization for services is not guarantee of payment.
Important Information for Payment:
W-9 Forms are required in order to get reimbursed by Neighborhood for authorized services. If this has not previously been sent, please submit with this request.