Nh medicaid prior authorization form: Fill out & sign online

Here's how it works

01. Edit your nh medicaid prior authorization form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out nh medicaid prior authorization with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the nh medicaid prior authorization in the editor.
Begin with SECTION I: PATIENT INFORMATION AND MEDICATION REQUESTED. Fill in the patient's last name, first name, Medicaid ID number, date of birth, and gender. Specify the drug name, strength, dosing directions, and length of therapy.
Proceed to SECTION II: PRESCRIBER INFORMATION. Enter the prescriber's last name, first name, specialty, NPI number, phone number, and fax number.
In SECTION III: CLINICAL HISTORY, answer all questions regarding the patient's diagnosis and treatment history. Provide detailed responses for any trials or failures of previous therapies.
Ensure all information is accurate and complete. Sign at the bottom of the form as a prescriber and include the date.
Finally, utilize our platform's features to save your completed form and send it via fax to Magellan Rx Management or DHHS as required.

Start using our platform today for free to streamline your nh medicaid prior authorization process!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Contact us

Does NH Medicaid require prior authorization?

Requests for services from a provider, facility, or vendor that is not in the NH Healthy Families network need to be approved by getting a prior authorization. Your healthcare provider can tell you if a medical service or prescription needs prior authorization.

Which types of procedures may need pre authorization under Medicaid?

For example, services that may require pre-certification include outpatient and inpatient hospital services, observation services, invasive procedures, CT, MRI and PET scans, and colonoscopies.

Does Medicaid use prior authorization?

States have authority over prior authorization practices in Medicaid and can implement prior authorization regulations that are stricter than federal requirements (Medicaid Health Plans of America (MHPA) 2023). Medicaid statute provides authority for utilization review in Medicaid ( 1902(a)(30) of the Act).

What is the phone number for Medicaid prior authorization in NH?

How do I request a prior authorization? Requests for prior authorization must be initiated by the prescriber and may be initiated via phone, fax or mail. The Prime Therapeutics phone number is 1-866-675-7755 and the fax number is 1-888-603-7696.

Is prior authorization always required?

Is prior authorization required in emergency situations? No, prior authorization is not required if you have an emergency and need medication. However, coverage for emergency medical costs are subject to the terms of your health plan.