Policies and Guidelines

• Clinical Medical Policies
• Billing Guidelines and Payment Policies
• Durable Medical Equipment (DME) Guide for Frequency, Quantity Limits, and Prior Authorization Requirements (Updated November 6, 2023)
• Prior Authorization Information – New Neighborhood PA Search Tool!
• InterQual® Transparency Tool  – Please Note: By clicking this link, you are leaving the Neighborhood INTEGRITY (Medicare-Medicaid Plan) website and going to the non-INTEGRITY product website.

Note: Not all procedures, services, equipment, and supplies found using the InterQual® Transparency Tool may be covered by a member’s benefit plan.

Members, please check your handbook or call Neighborhood Member Services for benefit coverage details:

• • INTEGRITY (Medicare-Medicaid Plan) Members
    • CLICK HERE
    • Call 1-844-812-6896 (TTY 711), 8 a.m. to 8 p.m., Monday – Friday; 8 a.m. to 12 p.m. on Saturday. On Saturday afternoons, Sundays, and holidays, you may be asked to leave a message. Your call will be returned within the next business day. The call is free.
  • Medicaid Managed Care Plan Members
    • CLICK HERE
    • Call 1-800-459-6019 (TTY 711) 8 a.m. to 6 p.m., Monday – Friday
  • Commercial Plan Members
    • CLICK HERE
    • Call 1-855-321-9244 (TTY 711) 8 a.m. to 6 p.m., Monday – Friday
  • Providers
    • Use the links above to review the appropriate member handbook for benefit coverage details.
    • Call Neighborhood Provider Services at 1-800-963-1001 (TTY 711) 8 a.m. to 6 p.m., Monday – Friday