- Adult Day – e-form (Reference Guide for Adult Day Services Requests)
- Ambulance Request – e-form
- Assisted Living – e-form
- Bariatric Bypass Surgery – e-form
- Behavioral Health Services – e-form
- Breast Reduction – e-form
- General Auth Request Form – e-form
- Genetic Testing – e-form
- Home Care Services – e-form (Home Care Prior Authorization Form Guide)
- Home Infusion Form -e-form
- Hospice Form – e-form
- In Lieu of – e-form
- Minimum Data Set (MDS) Authorization Form – e-form
- Out Of Network Form – e-form (For Transplant and Behavioral Health requests, please use the specific prior authorization form for the service, not the out-of-network prior authorization form)
- Outpatient Surgery – Request/Checklist – e-form
- Pain Management Request – e-form
- Pharmacy General Medical Authorization – e-form
- Sleep Study Prior Authorization – e-form
- SNF/Acute Rehab/LTAC – Initial Request ONLY – e-form
- Spinal Cord Simulator – e-form
- Termination of Pregnancy – e-form
- Transplant Checklist – e-form
Make Sure Your Request Requires Prior Authorization
Neighborhood is receiving authorization requests for services that do not require PA. In an effort to save you time and reduce administrative burden, please consult the new Neighborhood Prior Authorization Search Tool, before submitting a PA request.
With a quick search function by procedure/service code, the PA Guides display any authorization requirements. Start saving time today!
PLEASE NOTE: AUTHORIZATION IS NOT A GUARANTEE OF PAYMENT