What is prior authorization?
Prior authorization (PA) means the health plan must approve certain care before it will cover it. Providers often submit requests for you, but you still have rights if PA is denied or delayed.
Overview: Prior authorizations. New Hampshire-only details below.
Confirm plan type: New Hampshire: Start Here.
New Hampshire PA rules
Major PA reforms took effect January 1, 2025 under Senate Bill 561, which reenacted RSA 420-J:6 and related utilization review rules in RSA 420-E:4. These apply to most fully insured managed care plans—not Medicare, Medicaid fee-for-service, or typical self-funded ERISA plans.
Service PA deadlines (RSA 420-J:6, V–VI)
- Electronic submission — non-urgent: decision within 3 business days after all necessary information is received
- Electronic submission — urgent: within 48 hours (as fast as the condition requires)
- Non-electronic — non-urgent: within 6 business days
- Non-electronic — urgent: within 72 hours
- If the carrier or utilization review entity misses applicable deadlines after receiving necessary information, the PA is deemed approved (RSA 420-E:4, IV; carrier bulletin INS 25-001-AB)
Prescription drugs (RSA 420-J:7-b)
- Response within 2 business days after the prescriber submits a complete clinical rationale
- If PA exceeds 2 business days, the prescription is considered approved (§ 420-J:7-b, II-b)
- Uniform NH prior authorization forms for prescription drugs (electronic and paper standards)
Other protections
- Carriers must post PA requirements and clinical criteria online; 60 days' notice before new PA rules (RSA 420-J:6, II)
- Peer-to-peer review available within 2 business days of request (RSA 420-J:6, X)
- Approved PA protected for 60 business days if care is provided in that window (RSA 420-J:6, VIII)
- No PA for first 2 routine SUD outpatient visits; limited PA rules for short-term SUD inpatient stabilization (RSA 420-J:17)
- At least one medication-assisted treatment option without PA (RSA 420-J:18)
Where to look up PA rules
Carriers must publish PA criteria on their websites. Use your denial letter first, then your plan's provider or member portal.
Carrier links: New Hampshire prior auth & internal appeals links.
Medicaid
SB 561 does not apply to Medicaid fee-for-service, but Medicaid managed care plans follow federal PA rules and MCO timeliness requirements. Denials use MCO grievance and DHHS fair hearing paths—see New Hampshire internal appeals.
If PA is denied
Request peer-to-peer review if offered, then file an internal appeal within 180 days of the denial (RSA 420-J:5).
Urgent care
Mark requests urgent when delay would seriously jeopardize life, health, or ability to regain maximum function. Deadlines are 48 hours (electronic) or 72 hours (non-electronic) under RSA 420-J:6.
Expedited internal appeals must be decided within 72 hours (RSA 420-J:5, III–IV).