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Referrals and Authorizations

Referrals

A referral is a special permission that is normally given by your primary care provider (PCP) for you to see a specialist. Examples of specialists are cardiologists (heart doctors), dermatologists (skin doctors) and allergists (allergy doctor). NHP requires a referral for you to receive care from any NHP in-plan specialist.

Your PCP must begin the process for obtaining the referral. They can communicate directly with specialists and are required to obtain a referral ID number from us (Neighborhood Health Plan) for these services.

It is up to you to make sure that the specialist you wish to see is available and in NHP’s network. You can find a specialist by using our Find a Doctor tool or call the NHP Member Service Center at 1-800-462-5449 (TTY 1-800-655-1761).

Authorization

An authorization is a special approval by NHP for payment of certain services. Examples of services requiring Authorization from NHP are surgical procedures, planned admissions, and inpatient psychiatric care. When an Authorization is needed, it must be given before you receive the service in order for NHP to cover it. Your PCP or the Specialist treating you will request an Authorization if it is necessary.

Coverage for services from a non-network provider requires authorizationp. See a list of services requiring prior authorization.