Claim Appeal Request Form

NHP has a formalized process for handling provider claim inquiries and claim appeals. Following are the details of when and how to utilize the claim appeals process.

What: A written request for the purpose of requesting NHP to reconsider its decision on how a claim was originally processed.
How: Claim appeals must be requested in writing. Please use the appeals form.
Who: The provider or the office staff of the provider may request a claim inquiry.
Where: The Claims Appeal form, along with all accompanying documentation, should be mailed to the NHP Provider Claims Appeals,
P.O. Box 5210 Kingston, NY. 12402-5210.
When:

 

 

Please be advised you have 1 year from the date of occurrence to file an appeal with the Plan. Claim appeals should only be requested after completing the inquiry process and receiving a response back from NHP. You can appeal if you disagree with the response from the inquiry or have additional information, which may warrant NHP to re-evaluate its original decision. Supporting documentation that substantiates the reason for the appeal, including a complete copy of the medical records and claim form, must be attached to the appeal request form. The provider will receive a decision, in writing, within 60 calendar days from the date appeal is received by NHP.

 
NHP will respond back to you in writing on all claim inquiries that do not result in the re-adjudication of the claim. You must file a claim inquiry BEFORE you file a claim appeal.
   
   
If you would like more information on NHP's formalized process for handling provider claim inquiries and claim appeals, please contact us.

Resources

FAQs
Frequently Asked Questions 

myNHP.com Tutorials. Learn how to View Claim Status, Check Member Eligibility, Submit/Auth Referrals, and much more 

Policies, Protocols, and Administrative Guidelines 

Clinical Practice Guidelines Links to nationally recognized sources. 

Utilization Management. Learn about the UM process at NHP 

United Behaviorial Health (UBH)
The Importance of Collaboration between Primary Physicians and Behaviorial Health Clinicians. 

Links

Neighborhood Additions Program
Member Support and Education during Pregnancy and High-risk Screening