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NHP prior authorization guidelines

Here are the NHP guidelines for all the services that typically require prior authorization. When it’s helpful, we’ve also included a summary of the relevant benefit information. If you have any questions about NHP clinical policies, please call provider services at 855-444-4647.

Sleep Management Program

Sleep study requests and authorizations, as well as CPAP equipment, may be obtained by visiting the Sleep Management Solutions website.

Utilization Management Programs through eviCore Healthcare

UM Programs Requiring Authorization

Visit the Neighborhood Health Plan specific website at https://www.evicore.com/healthplan/NHP to view the full list of CPT codes that require authorization through eviCore healthcare for the following services:

  • High-Tech Radiology
  • Non-OB Ultrasounds and Cardiac Imaging
  • Molecular and Genetic Testing;
  • Radiation Therapy

Clinical Guidelines and Clinical Quick Reference Guides

To view the Cardiology, Non-OB Ultrasound, High-Tech Radiology Imaging and Radiation Therapy Clinical Guidelines and quick reference guides visit eviCore healthcare’s Provider Resources website. Select the appropriate Solution from the dropdown to view the specific clinical guidelines and quick reference guides to the following areas:

  • Abdomen
  • Cardiac
  • Chest
  • Head
  • Musculoskeletal
  • Neck
  • Oncology
  • Pelvis
  • Peripheral Nerve Disorders (PND)
  • Peripheral Vascular Disease (PVD)
  • Spine
  • Pediatric Abdomen
  • Pediatric Cardiac
  • Pediatric Chest
  • Pediatric Head
  • Pediatric Musculoskeletal
  • Pediatric Neck
  • Pediatric Oncology
  • Pediatric Pelvis
  • Pediatric Peripheral Nerve Disorders (PND)
  • Pediatric Peripheral Vascular Disease (PVD)
  • Pediatric Spine