Request for Claim Review 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 inquiry process.

What: A request either verbally or in writing, to request a review of a particular claim, or a further explanation regarding the disposition of a claim.
How:
  • Click Access eServices, login and submit online. (Must be a registered user.)

  • Contact Customer Service at (877) 972-8845.

  • Complete and mail the Claim Review Form. (Documentation sent to the plan should include the     corresponding form or must clearly explain the nature of the review request.)

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    Who: The provider or the office staff of the provider may request a claim inquiry.

    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.

     

    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