Prior Authorization Guidelines for NHP plans and members.
At your fingertips: Below please find our Prior Authorization Guidelines for all services that customarily require prior authorization and/or notification.
Limited benefit information has been included when this information is necessary to support a prior authorization, notification, or referral requirement.
Radiology Management Program
Authorization and corresponding authorization numbers for high technology imaging services may be obtained by:
Before scheduling a service for a member, providers should check eligibility and evidence of coverage for that member’s health care plan.
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 Authorizations for Durable Medical Equipment (DME), Medical Supplies, Oxygen Related Equipment, Orthotics and Prosthetics (Effective 1/1/13)
Sleep Management Program
Sleep study requests and authorizations, as well as CPAP equipment, may be obtained by visiting the Sleep Management Solutions website.