Prior Authorization

What is Prior Authorization?

Prior Authorization is a request to get approval from Neighborhood before receiving treatment. The review process and determination is based on medical necessity. We will review the information submitted including medical records. If we need additional information we may contact your provider.

Prior authorization update: We want you to get care quickly

As of June 11, 2021, Neighborhood will continue to waive prior authorizations for all non-pharmacy medical and behavioral health primary COVID-19 related diagnostic and treatment services through August 31, 2021. Neighborhood has resumed all other prior authorization requirements according to your Plan benefits.

For questions on your plan benefits, please contact Neighborhood Member Services:

INTEGRITY (Medicare-Medicaid Plan)
Monday through Friday, 8 a.m. to 8 p.m.
Saturday, 8 a.m. to 12 p.m.
1-844-812-6896 (TTY 711)

For information on COVID-19, visit our COVID-19 Updates page.

What services require Prior Authorization?

To check if a service requires Prior Authorization contact Member Services at 1-844-812-6896 (TTY 711), 8 am to 8 pm, Monday – Friday; 8 am to 12 pm on Saturday. You may also check if a service or code is covered by going to the Member Handbook (Evidence of Coverage).

Please note that emergency care, urgent care, family planning and dialysis, in or out of network, do not require a prior authorization.

What is the process for obtaining Prior Authorization?

For standard requests a decision is made within 14 calendar days from the date the request was received. A written notice of the decision will be sent to the member and provider.

For expedited requests a decision is made within 72 hours from the date the request was received. Neighborhood will inform the member and provider of the decision. Neighborhood utilizes Clinical Medical Policies and InterQual for medical necessity criteria which are available upon request. The Clinical Medical Policies are available here.

Prior authorization is not a guarantee of payment. All providers are advised to check eligibility before rendering services.

To submit an online Prior Authorization please click here to fill out the Online Prior Authorization Form.

Members may initiate a Prior Authorization request by calling Member Services for assistance.

Integrity: 844-812-6896 (TTY 711)

Medicaid/ACCESS/Rite Care, TRUST/Rhody Health Partners and RHP Expansion: 800-459-6019 (TTY711)

Commercial Plans: 855-321-9244 (TTY 711)

Have questions?

Please call us at 1-844-812-6896 (TTY 711), 8 am to 8 pm, Monday – Friday; 8 am to 12 pm on Saturday. On Saturday afternoons, Sundays and holidays, you may be asked to leave a message. Your call will be returned within the next business day. The call is free.

Neighborhood Health Plan of Rhode Island is a health plan that contracts with both Medicare and Rhode Island Medicaid to provide the benefits of both programs to enrollees.

ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call Member Services at 1-844-812-6896 (TTY 711), 8 am to 8 pm, Monday – Friday; 8 am to 12 pm on Saturday. On Saturday afternoons, Sundays and holidays, you may be asked to leave a message. Your call will be returned within the next business day. The call is free.

ATENCIÓN: Si usted habla Español, servicios de asistencia con el idioma, de forma gratuita, están disponibles para usted. Llame a Servicios a los Miembros al 1-844-812-6896 (TTY 711), de 8 am a 8 pm, de lunes a viernes, de 8 am a 12 pm los Sábados. En las tardes de los Sábados, domingos y feriados, se le pedirá que deje un mensaje. Su llamada será devuelta dentro del siguiente día hábil. La llamada es gratuita.

ATENÇÃO: Se você fala Português, o idioma, os serviços de assistência gratuita, estão disponíveis para você. Os serviços de chamada em 1-844-812-6896 TTY (711), 8 am a 8 pm, de segunda a sexta-feira; 8 am a 12 pm no sábado. Nas tardes de sábado, domingos e feriados, você pode ser convidado a deixar uma mensagem. A sua chamada será devolvido no próximo dia útil. A ligação é gratuita.

សូមយកចិត្តទុកដាក់៖ ប្រសិនបើអ្នកនិយាយភាសាខ្មែរ មានសេវាកម្មជំនួយផ្នែកភាសា​ដោយមិនគិតថ្លៃសម្រាប់អ្នក។ សូមទូរស័ព្ទទៅសេវាសមាជិកតាមរយៈលេខ 1-844-812-6896 (TTY 711) ចាប់ពីម៉ោង 8 ព្រឹកដល់ 8 យប់ថ្ងៃចន្ទ – សុក្រ ម៉ោង 8 ព្រឹកដល់ 12 យប់នៅថ្ងៃសៅរ៍។ នៅរៀងរាល់រសៀលថ្ងៃសៅរ៍ ថ្ងៃអាទិត្យ និងថ្ងៃឈប់សម្រាក អ្នកអាចត្រូវបានស្នើសុំឱ្យទុកសារ។ ការហៅរបស់អ្នកនឹងត្រូវបានគេហៅត្រឡប់មកវិញក្នុងថ្ងៃធ្វើការបន្ទាប់។ ការទូរស័ព្ទគឺឥតគិតថ្លៃ។

Our plan can also give you materials in Spanish, Portuguese, and Khmer in formats such as large print, braille, or audio. Call Neighborhood INTEGRITY Member Services to make a standing request to receive your materials now and in the future, in your requested language or alternate format. Call Neighborhood INTEGRITY Member Services to make a standing request to receive your materials now and in the future, in your requested language or alternate format.

Last updated: Jul 1, 2021 @ 1:53 pm

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