Frequently Asked Questions

Frequently Asked Questions

• Q: How can I obtain my Provider Identification Number?
  A: If you recently submitted an application to participate in Neighborhood Health Providers (NHP) provider network, you will receive a letter from us with your provider identification number and effective date once your application has completed the credentialing process. In most cases, your provider identification number is your license number with 01 on the end. You may also verify your provider identification number by calling our Provider Services Department toll free at 1-800-558-7970. Provider identification numbers are also listed in NHP's Provider Directory, which is available on this website.

• Q: What are the Provider Services Departments hours of operation?
  A: You can speak to a Provider Services Advocate by calling our Provider Services Department toll free at 1-800-558-7970. The department is open Monday through Friday, from 9 a.m. to 5 p.m. At other times, you may access eligibility verification and claims status through NHP's Interactive Voice Response (IVR) system.

• Q: What is the NHP Provider Web Portal and how do I access it?
  A: The NHP Provider Web Portal allows you to review Primary Care Provider (PCP) panel assignments, verify member eligibility, submit claims electronically, obtain claim status, request a review or appeal of a claim, submit requests for pre-authorization of services, and obtain authorization status. To access the web portal, 24 hours a day, 7 days a week, click the silver NHP Online Provider Web Portal button, located at the top of each provider page. If you have not already done so, you will need to create an account to use the Web Portal. For brief instructions on set-up and use, please view our Web Portal quick reference guide by clicking here. You may also call our Provider Services Department at 1-800-558-7970 for assistance.

  

• Q: When can I use the Interactive Voice Response (IVR) System?
  A: The IVR is available 24 hours a day, 7 days a week.

• Q: What information do I need to use the Interactive Voice Response (IVR) System to obtain claim status and member eligibility verification?
  A: Simply call 1-800-558-7970, toll free, and follow the system prompts to use the automated services. For claim status, you will need the member ID, date of service and the tax identification number (TIN) submitted on the claim. For member eligibility verification, you will need the member ID.

• Q: When using the Interactive Voice Response (IVR) System to obtain claim status, should I enter the Tax Identification Number (TIN) that was submitted on the claim or my own TIN?
  A: You must enter the TIN that was submitted on the claim.

• Q: I would like to submit claims to NHP electronically. How can I get set up? What is NHP's WebMD submitter number?
  A: If you would like to submit claims electronically, please contact NHP's EDI Coordinator at 1-631-881-2470. NHP's WebMD submitter number is 11325.

• Q: Does NHP have timely filing guidelines?
  A: Yes, NHP requires that all claims be submitted within 90 days from the date of service.

• Q: Is a referral from a Primary Care Practitioner (PCP) to an in-network specialist required?
  A: No. As of 8/2/2010, referrals are no longer needed from the PCP to an in-network specialist.

• Q: Does NHP send an Explanation of Benefits (EOB) notification to its members?
  A: Only members who were part of NHP's Medicare Plan routinely receive EOB notifications. Although NHP no longer offers a Medicare product in New York, there are still claims activities (e.g., run-out, adjustments and incorrect billings) that produce Medicare EOBs. For all other products, NHP provides its members with written notification, which includes appeal rights, when services are denied due to lack of medical necessity or lack of authorization.

Phone/Contact Reference Sheet

• Neighborhood Health Providers
  521 Fifth Avenue, 3rd Floor
  New York, NY 10175
  
  Corporate Phone:1-212-883-0883
  Fax: 1-212-808-4772

• Neighborhood Health Providers
  Member Services
  P.O. Box 19769
  Charlotte, NC 28219-9769
  
  Phone: 1-800-826-6240

• Neighborhood Health Providers
  Provider Services
  P.O. Box 6008
  Hauppauge, NY 11788-9007
  
  Phone: 1-800-558-7970
  

• Neighborhood Health Providers
  Claims and Inquiries
  P.O. Box 6008
  Hauppauge, NY 11788-9007
  
  Phone: 1-800-558-7970
  Fax: 1-646-517-5836

• Neighborhood Health Providers
  Care Coordination Department
  c/o Royal Health Care
  4944 Parkway Plaza Blvd. Suite 110
  Charlotte, NC 28217
  
  Precertification: 1-800-765-3805
  Fax: 1-800-338-4195

• NHP Behavioral Health Services (Chemical Dependence/Mental Health)
  Beacon Health Strategies
  Customer Service Representative: 1-866-969-2661

• NHP Vision Services
  Davis Vision
  Customer Service Representative: 1-800-999-5431

• NHP Dental Services
  DentaQuest
  Customer Service Representative: 1-888-307-6549

• NHP Pharmacy Services
  Express Scripts
  Customer Service Representative: 1-877-782-8655