Clinical Coverage Criteria

These Clinical Criteria are not intended to certify coverage availability. While services or technology may be determined by Neighborhood Health Plan as medically necessary, it may not be part of a Member's benefit plan. Please contact our Customer Service Center at 800-462-5449 for verification that a service is covered under a particular benefit plan. The definition of the term "medical necessity" is the definition contained in the NHP Provider Manual in effect on the date of the medical service in question.

The foregoing criteria may be amended or rescinded at any time by NHP and NHP shall have the exclusive right to interpret and enforce its terms. To inquire on guidelines not listed here, please contact the Customer Service Center at 800-462-5449.

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