Prior Authorizations

DISCLAIMER

The following attempts to provide the most current information for the Prior Authorization Lookup Tool. Please note that this information may be subject to change, and a prior authorization is NOT a guarantee of payment. Payment is dependent on a number of factors, including but not limited to member eligibility on the date of service, coverage limitations and exclusions, provider contracts, and correct coding and billing for the services at issue. AmeriHealth Caritas New Hampshire reserves the right to adjust any payment made following a review of the medical records and determination of medical necessity for the services rendered. All non-participating providers must submit requests for prior authorization, except as may be required by law. For additional details, or if you are uncertain that prior authorization is needed, please see the Provider Manual on the AmeriHealth Caritas New Hampshire website.

Prior authorization lookup tool

The results of this tool are not a guarantee of coverage or authorization. All results are subject to change in accordance with plan policies and procedures and the Provider Manual (PDF).

Find more information on submitting prior authorization requests.

Prior authorization is NOT required for Emergency Room Services, or for Family Planning services billed with a contraceptive management diagnosis.
Note: All chiropractic and acupuncture services require authorization through the Living Beyond Pain program. For authorization, please call 1-833-212-2264.
For specialty vendors, please verify prior authorization requirements with the following contracted vendors:
Prior authorization must be submitted for all services delivered by nonparticipating providers. Nonparticipating providers can also choose to (PDF).
AmeriHealth Caritas New Hampshire providers are responsible for obtaining prior authorization for certain services. Your claim may be denied or rejected if the prior authorization was not obtained before the service was rendered.

Prior authorization is not a guarantee of payment for the service authorized. AmeriHealth Caritas New Hampshire reserves the right to adjust any payment made following a review of the medical record or other documentation and/or determination of the medical necessity of the services provided.

How to obtain prior authorization

Submit authorizations electronically

AmeriHealth Caritas New Hampshire offers our providers access to Medical Authorizations for electronic authorization inquiries and submission. The Medical Authorizations portal is accessed through NaviNet located on the Workflows menu.

In addition to submitting and inquiring on existing authorizations, you will also be able to:

  • Verify if no authorization is required
  • Receive auto-approvals, in some circumstances
  • Submit an amended authorization
  • Attach supplemental documentation
  • Sign up for in-app status-change notifications directly from the health plan
  • Access a multi-payer authorization log
  • Submit inpatient concurrent reviews online if you have Health Information Exchange (HIE) capabilities (Fax is no longer required.)
  • Review inpatient admission notifications and provide supporting clinical documentation

Resources and guides

Go to our NaviNet page or our training page for more.

Providers