Specialty Care Visits
To make accessing specialty care an easy process for both members and providers, a referral from your primary care provider (PCP) to see a specialist is not required in most cases. See our Prior Authorization and Referral Policy for full guidelines.
Your Primary Care Provider
Your Primary Care Provider (PCP) will coordinate all routine care for you and your family, and arrange for specialty care, if needed. In addition, your doctor can refer you to NHP's clinical programs, or arrange for hospital care.
Unless it is an emergency, you should always call your PCP first when you or your family member gets sick.
Choosing a PCP
All Members must choose a Primary Care Provider upon enrollment in NHP. Each family member covered by NHP may choose a different Primary Care Provider and/or Primary Care Site. If you do not choose a Primary Care Provider or Primary Care Site within fifteen (15) days of your enrollment date, NHP may assign one to you.
NHP Primary Care Providers practice at over 250 primary care sites, including community health centers, hospital-based group practices, multi-specialty group practices and Harvard Vanguard Medical Associates locations. Visit our Provider Directory for more information.
Changing your PCP
Members can change their PCP by calling NHP's Member Service Center at 1-800-462-5449. Some plans limit the number of times members can change their PCPs - please check your plan materials.
Behavioral Health Providers
Beacon Health Strategies manages NHP's Behavioral Health Care benefit. To find a behavioral health provider, please visit the Beacon Health Strategies web site.
When you are Sick
If you or a family member is sick, but it is not an emergency, call your Primary Care Provider - he or she will advise you on what to do next. Medical advice from your Primary Care Site/Provider's Office should be available 24 hours a day.
Emergency Room (ER) Visits
In an emergency, go to the nearest ER or call 911. Emergency room visits are covered for all members. No referral is necessary. Your PCP should be informed of your ER visit within 48 hours of your receiving Emergency services.
Hospital stays and procedures should be arranged by your Primary Care Provider.