Forms

Prior Authorization Request Forms

NEW! Claim Reconsideration Request - Electronic Form
Neighborhood has been working hard to make doing business with us easier and we are pleased to announce a new submission option for claim reconsideration requests via electronic form (eForm).  Please see the Electronic Reconsideration Request E-form Instructions for help with completing the eForm. Use of the Claim Reconsideration Request eForm will be mandatory June 1, 2022 and requests that are faxed, mailed, or emailed will not be processed.