New Hampshire Application Service Provider Agreement
Description
How to fill out Application Service Provider Agreement?
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FAQ
As a member, you do not have to pay for medically necessary covered services you get from a New Hampshire Medicaid provider. If you get a bill or statement, call AmeriHealth Caritas New Hampshire Member Services, 24 hours a day, seven days a week, at 1-833-704-1177 (TTY 1-855-534-6730).
We are AmeriHealth Caritas New Hampshire, a mission-driven Medicaid managed care organization. Through dedicated providers like you, we serve New Hampshire Medicaid members in the Medicaid Care Management (MCM) program. Working with you, we aim to deliver excellent care and improved health outcomes to our members.
Who is eligible for New Hampshire Medicaid? Household Size*Maximum Income Level (Per Year)1$19,3922$26,2283$33,0644$39,9004 more rows
Economic Benefits Since Medicaid Expansion was first implemented in New Hampshire from August 2014 until June 2022, the program has brought nearly $3.23 billion in federal funds to New Hampshire, supporting the health of Granite Staters and the economy.
NH Medicaid Provider Enrollment To enroll as a NH Medicaid provider, visit the New Hampshire MMIS Health Enterprise Portal and click on Provider in the upper left of the page.
NH Medicaid (Medical Assistance) is a federal and state funded health care program that serves a wide range of individuals and families who meet certain eligibility requirements.
For a Change in Ownership, certified health facilities need to complete the CMS 855 A form. Completed forms need to be sent to your fiscal intermediary for processing.
Non-participating providers must submit Prior Authorization for all services. For non-participating providers, Join Our Network. Urine Drug Screens rendered by MAT (Medication Assisted Treatment) providers require notification only. Prior auth is not required.