New Hampshire Network Affiliation Agreement
Description
How to fill out Network Affiliation Agreement?
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FAQ
If you have questions, please contact Provider Enrollment at (603) 223-4774 or (866) 291-1674, Monday through Friday, 8 am - 5 pm EST. If you would like to become a Trading Partner (EDI) to electronically exchange data with New Hampshire Medicaid, please complete the online Trading Partner application.
Contact the DHHS Customer Service Center toll-free at 1-844-ASK-DHHS (1-844-275-3447) (TDD Relay Access: 1-800-735-2964), Monday through Friday, a.m. to p.m. ET.
You can call the NH Medicaid Provider Relations Call Center at 1-866-291-1674 or 603-223- 4774, Mon ? Fri, from AM to PM and they can tell you if a provider is enrolled in NH Medicaid.
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.
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.