Transcription of NHHF - Standardized Prior Authorization Form Instructions
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NHHF - Standardized Prior Authorization Form Instructions
03/19/2018 Standardized Prior Authorization Form Instructions The Standardized one-page Prior Authorization Request Form is to be used by all NH medicaid Fee for Service (FFS) and Managed Care Organization (MCO) service providers to obtain service Authorization for their medicaid -enrolled beneficiaries for specific services that require service Authorization . This does not substitute NH medicaid Fee-for-Service or NH medicaid Managed Care Organization Service Authorization policies and a copy of all supporting information is still required.
Mar 19, 2018 · The form should be used for all MCO and NH Medicaid FFS services requiring authorization with the exception of: 1- Behavioral health services 2- Radiology 3- NEMT 4- Pharmacy in most instances, see item 3 below for clarification 5- DME for Well Sense and NH Medicaid FFS. NHHF uses the form for DME at this time.
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