The New Hampshire Medicaid Program has contracted with Schaller Anderson Medical Administrators, Inc., to perform its medical services and durable medical equipment prior authorization activities, which were previously completed by state staff in the Prior Authorization Unit and state Behavioral Health staff in the Psychotherapy Service Limits Override Unit.  Beginning July 9, 2007, all requests for prior authorizations, with the exception of augmentative communication device requests, diagnostic radiology, and certain pharmaceutical services must be submitted to:

Schaller Anderson Medical Administrators, Inc.

NH Medicaid Prior Authorization Unit

53 Regional Drive Suite 201

Concord, NH 03301

Toll free Telephone:  (866) 499-9335

Toll free Fax:  (866) 499-9334

Prior Auth. Email:  AuthRequests@SchallerAnderson.com

Clinical Prior Authorization and Notification Request Forms

• Panniculectomy Prior Authorization Request (pdf - 2 pages)
• Reduction Mammaplasty Prior Authorization (pdf - 2 pages)
• Gastric Bypass Surgery Prior Authorization Request (pdf - 2 pages)
• Durable Medical Equipment/Medical Supply Prior Authorization Request (pdf - 1 page)
• Request for Prior Authorization in Excess of Service Limits  (pdf - 1 page)
• Request for Prior Authorization in Excess of Service Limits/Psychotherapy Services (pdf -3 pages)
• Mobility Evaluation (pdf - 5 pages)
• Medical Equipment Request Evaluation/Non-Wheelchair (pdf - 3 pages)
• Pregnancy Notification  (pdf - 1 page)
• CPAP & BiPAP Machine PA Request (1 page)

Children's Hospital of Boston-Out of State Prior Authorization for Inpatient Admission

• Out of State Prior Authorization Form
• Provider Letter
• Provider Questions & Answers