Prior Authorization Reference Guide – Search Tool

  • The purpose of these guides (below, by line of business) is to inform you of services that require prior authorization.
  • 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 Provider Services at 1-800-963-1001.
  • All Acute and Post-Acute admissions require authorization.
  • Neighborhood Health Plan of RI utilizes the following criteria to make medical review decisions:
    • InterQual
    • Clinical Medical Policies
  • 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.
  • For the following areas: Radiology, Oncology and Durable Medical Equipment please see our partnered vendor information below regarding authorization requirements

Enter a procedure/service code to determine if prior authorization is required.

Select member's line of business: *