Policies and Guides

Legal Compliance Policies

• Compliance Hotline Policy
• Fraud Reporting & Whistleblower Protections Policy
• Non-Retaliation for Reporting of Compliance Violations Policy

Radiology Management Program

• Prior Authorization Codes for High-tech Radiology Services

Prior Authorization

• Prior Authorization Guidelines
• Surgical Day Care (SDC) Fact Sheet
• Services Requiring Electronic Submission for Prior Authorization or Notification
• Evidence Based Clinical Information to Support a Spinal Surgery Authorization Request

To reach our afterhours coverage for urgent authorization or care management needs which cannot wait until the next business day, please call us at 1-800-432-9449 and follow the prompts.

Prior Authorization Exemptions for DME, Orthotics & Prosthetics

Effective Through 12/31/12

• Prior Authorization Exemptions

Prior Authorization Required for DME, Medical Supplies, Oxygen Related Equipment, Orthotics and Prosthetics

Effective 1/1/13

• DME Prior Authorization List

Provider Payment Guidelines

For a complete listing of NHP's provider payment guidelines, click here.

Bundled Codes/Services

For a complete listing of NHP's Bundled Codes/Services, click here.