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
eviCore prior authorizations
Some services now require authorization through eviCore healthcare, including durable medical equipment, genetic testing, oncology, and more. Learn more and request authorizations on our eviCore page.
Resources and guides
- NaviNet Medical Authorizations Participant Guide (PDF)
- NaviNet Medical Authorizations Frequently Asked Questions (FAQ) (PDF)
- Tutorial video — Prior Authorization Inquiry Process
- Tutorial video — Prior Authorization Submission Process