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Provider Quick Reference Guide

Business Processes and Transition to MCM

Starting on December 1, 2013, most NH Medicaid recipients will be enrolled in one of three contracted managed care organizations (MCOs). When the Medicaid Care Management (MCM) program starts, Medicaid services, with some exceptions, will be provided by the Health Plan’s provider network. The services covered by NH Medicaid will be covered by each of the Health Plans. However, how those services are delivered, and how the claims are submitted will change.

The Quick Reference Guide will contain many basic business processes and information for each of the Health Plans, such as service providers, member support, prior authorizations (in-and-out of Network), claims submission and payment and provider grievances and appeals. This information is intended to assist NH Medicaid providers through the transition to Medicaid Care Management and is subject to change. Providers should consult the Provider Manual, visit the Provider Portal, or call the Provider Call Center for the most up-to-date and detailed information for the Health Plans.

The Department of Health and Human Services in partnership with the University of New Hampshire is offering a training session in conjunction with the release of the Quick Reference Guide. Medicaid Care Management Operations: Managing Business Processes on Tuesday, November 12, 2013 from 9:00am-1:00pm. Both in-person and webinar attendance are available. The Grappone Conference Center, 70 Constitution Avenue, Concord NH, 03301, will be the site for in-person attendance.

There is still space available – if you plan to attend, please register using the link below as soon as possible. All attendees are required to register in advance.

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New Hampshire Department of Health and Human Services
129 Pleasant Street | Concord, NH | 03301-3852

copyright 2016. State of New Hampshire