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​Provider Payment Guidelines

Our Provider Payment Guidelines make it easy for providers to know exactly what medically necessary services are covered, and under what conditions.*

Payment guidelines answer common provider questions and give information on:

  • Payment guidelines
  • Prerequisites, if applicable
  • Procedure codes (and their descriptors)
  • Limitations
  • Exceptions to policy
  • Member cost-sharing
  • Definitions
  • What NHP reimburses
  • What NHP does not reimburse

To inquire on guidelines not listed here, please e-mail your Provider Relations Representative directly, or email the Provider Relations Dept. at prweb@nhp.org. Or, call our Provider Services line at 1-855-444-4647 for verification that a service is covered for a specific member.

Practice Managers, meet your new administrative assistant: Our Bundled Codes/Services list

Here we provide a complete listing of NHP's Bundled Codes/Services list

 

Find a Payment Guideline from our alphabetical list:

*These guidelines are not intended to certify coverage availability. The definition of the term "medical necessity" is the definition contained in the Neighborhood Health Plan (NHP) Provider Manual in effect on the date of the medical service in question. The foregoing guidelines may be amended or rescinded at any time by NHP and NHP shall have the exclusive right to interpret and enforce its terms. While services or technology may be determined by NHP as medically necessary, it may not be part of a member's benefit plan. Click here to view NHP plan materials and benefit summaries or call our Customer Service Center at 1-855-444-4NHP (4647) for verification that a service is covered for a specific member.

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