Important change for Neighborhood Health Plan (NHP) MassHealth members.
Effective January 1, 2016, a prior authorization from NHP must be in place for MassHealth members to receive any non-emergent and non-urgent care at Boston Children’s Hospital and its affiliated sites. All prior authorization requests will be reviewed by NHP and will only be approved for limited circumstances and conditions.

This authorization review process does not apply to NHP Commercial members, MassHealth members with a Boston Children’s Hospital PCP, and members in the Special Kids Special Care Program for MassHealth.

Authorizations may be approved for limited circumstances and conditions at Boston Children’s Hospital and its affiliated sites, including when there are no other available contracted providers who can provide the medically necessary services to treat the member’s condition. (This process can take up to 15 calendar days for NHP to approve the visit).

If an approved prior authorization is not obtained before the patient receives services, the services will not be covered at Boston Children’s Hospital and its affiliate sites.

All existing authorizations and referrals to Boston Children’s Hospital and its affiliated sites that were approved in 2015 ended on December 31, 2015. Any service after January 1, 2016 will require a new authorization request and approval prior to a visit.

Referrals to specialists within our provider network at Newton Wellesley Hospital or Massachusetts General Hospital do not require prior authorizations. We are available to assist you in transitioning your child’s care to a specialist within our network when comparable services are available. These specialist visits do require a referral prior to the visit; however, that process can be completed much more quickly than a prior authorization. Please see the Referral Form under Our Office for the information needed by our staff to process your referrals.

Any questions about this policy should be directed to NHP’s Customer Services at 800-841-2900.


February Vacation for Public Schools Coming Up Soon – Week of Feb 15-19

If your child is due for an annual check-up and you want to book it during vacation week, please call soon to get a time that works best for you and your child!