- Application for Duplicate Remittance Advice (RA) Statement
- Appointment of Representative (AOR) Form
- Claim Adjustments
- Claim Form Finder
- Claim Reconsideration Request eForm
- Electronic Reconsideration Request E-form Instructions
- Clinical Medical Policy Review/Request Form
- Corrected (Replacement)/Voided Claim Request Form
- Electronic Payment and Remittance Advice Application
- Hospital Readmission Reevaluation Form
- ID Card Education Flyer (English) ID Card Education Flyer (Spanish)
- Interpreter Request Form – Note: Neighborhood will no longer accept the pdf/paper Interpreter Request Form after July 31, 2022
- Interpreter Request eForm
- Member Education Request Form – Updated October 15, 2021
- PCP Change Form (Revised April 6, 2022; Formerly the Member Site Change Request Form)
- Provider Claim Dispute & Provider-Initiated Appeal Form
- Provider Claim Dispute & Provider-Initiated Appeal – eForm
- Prior Authorization Request Forms
NEW! Claim Reconsideration Request - Electronic Form
Neighborhood has been working hard to make doing business with us easier and we are pleased to announce a new submission option for claim reconsideration requests via electronic form (eForm). Please see the Electronic Reconsideration Request E-form Instructions for help with completing the eForm. Use of the Claim Reconsideration Request eForm will be mandatory June 1, 2022 and requests that are faxed, mailed, or emailed will not be processed.