Requesting
Prior Authorization
Schaller Anderson Medical Administrators, Inc. (SAMAI) assumed responsibility for review and authorization of certain clinical services on behalf of the New Hampshire Medicaid Program, effective July 9, 2007. These review responsibilities apply to services on behalf of the entire Medicaid recipient population. This responsibility includes diagnostic imaging, transplants, bariatric surgery, cosmetic procedures, investigational procedures, Durable Medical Equipment (DME) and requests for service limits overrides for PT, OT, ST, office visits and psychotherapy. This responsibility will not include pharmacy* or augmentative communication devices.
* Prior authorization through Schaller Anderson is required for certain drugs, when those drugs are supplied and administered in a physician's office.
Generally a recipient's primary care provider is responsible for initiating and coordinating a request for authorization. However, specialists and other providers may need to contact the Prior Authorization department directly to obtain or confirm a prior authorization.
The requesting provider is responsible for complying with New Hampshire Medicaid's prior authorization requirements, policies and request procedures and for obtaining an authorization number. Providers must verify that any required authorization has been obtained before rendering service to a recipient.
Services that require prior authorization will be considered for payment only if prior authorization has been obtained. Schaller Anderson is not authorized to backdate authorizations for the New Hampshire Medicaid Program.
Forms
Prior authorization request forms can be found
here.
Prior Authorization Details
Prior authorization requests must be complete when submitted, including all clinical information, or the request will be denied for incomplete information.
For more information regarding prior authorization requests, please refer to the following sections of the provider manual: (Hyperlink to specific section in provider manual)
- Medical services requiring prior authorization or notification
- What to include in your request for prior authorization
- Timelines for processing prior authorization requests
- How to obtain reconsideration of prior authorization denials
W
here to submit prior authorization requests
A request for prior authorization should be submitted to the Schaller Anderson New Hampshire Medicaid Prior Authorization department by mail, telephone, fax or email as follows:
Telephone
(866) 499-9335
Fax
(866) 499-9334
Schaller Anderson Medical Administrators, Inc.
For questions, feel free to email us.
Medicaid Prior Authorization Unit
53 Regional Drive Suite 201
Concord, NH 03301
Reimbursement
Failure to obtain a prior authorization for services outlined above may result in the denial of a claim. In addition, when submitting the claim for the prior authorized service, it is important to include the prior authorization number in the appropriate space on the claim. Please direct all claims questions to EDS at: (603) 224-1747 or toll free at (800) 423-8303.