Specialty Medication Prior Authorization Criteria
Defines documentation and submission requirements for prior authorization requests for specialty medications for Neighborhood Health Plan of Rhode Island members; applies to providers submitting specialty drug prior auths.
No material clinical or coverage changes in this revision.
Documentation and Submission Criteria
Documentation and submission criteria
Required information for specialty medication prior authorization requests
ALL of the following
- Member's chart or medical record indicating medical necessity based on the corresponding criteria to the indication.
- Prior authorization requests for specialty drugs must be submitted by the provider's office and not by a third party.
Submission and Documentation Requirements — Provider Responsibilities
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