Administrative
- Appointment of Representative (AOR) Form
- ID Card Education Flyer (English) ID Card Education Flyer (Spanish)
- Interpreter Request E-Form
- Member Education Request Form
- PCP Change e-form
Claims
- Claim Adjustments
- Claim Form Finder – New! Updated August 9, 2023
- Claim Reconsideration Request E-Form
- Corrected (Replacement)/Voided Claim Request Form
- Duplicate Remittance Advice (RA) Statement Application
- Electronic Payment and Remittance Advice Application – Please email eftproviders@nhpri.org with requests or questions.
- Electronic Reconsideration Request E-Form Instructions
- Provider Claim Dispute & Provider-Initiated Appeal Form
- Provider Claim Dispute & Provider-Initiated Appeal – E-Form
Clinical
- Clinical Medical Policy Review/Request Form
- Home Care Discharge Communication Form – New! For Home Health Providers
- Home Care Gap Notification Form – New! For Home Health Providers Updated 5/15/2023
- Home Care Gap Notification – E-Form
- Hospital Readmission Reevaluation Form
- Prior Authorization Request Forms
New eForm for Requesting PCP Changes | Efficient, effective, easy!
Neighborhood is happy to announce an improvement in our PCP change process. Available immediately, providers can submit for PCP changes using the newly created PCP Change eForm (electronic form).
The new PCP Change eForm is a “smart form” so a user only needs to enter minimal information and the rest of the data will automatically populate in the eForm. After submitting the PCP Change eForm, providers will receive an email confirming their submission and can verify the request was completed in NaviNet after one business day.