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NH Medicaid Provider Information

Enrollment of Ordering, Referring, or Prescribing (ORP) Providers
Beginning September 3, 2019, non-Medicaid providers who order, refer, or prescribe for NH Medicaid beneficiaries in the state’s fee-for-service (FFS) program must enroll with NH Medicaid. This requirement also applies to medical and dental providers who write prescriptions. The ORP Federal regulation only applies to FFS. The ORP enrollment requirement does not apply to providers listed on claims submitted to the Managed Care Organizations (MCOs). For Managed Care Organizations (MCOs), please refer to your provider contract and the MCOs’ enrollment and claims processing requirements.

As outlined in Federal regulation 42 CFR 455.410, if an ORP provider is required or listed on a FFS claim, they must be enrolled with NH Medicaid and their NPI must be included on the claim. A referring provider is not required on the claim but if one is listed, then that referring provider must be enrolled in NH Medicaid.

If a provider is already enrolled with NH Medicaid, as either a billing or rendering provider, they do NOT have to enroll as an ORP provider. NH Medicaid has a new, streamlined online application for all non-billing providers: rendering or ORP. This shortened enrollment application will be available on the MMIS online portal the first week of September 2019.

NH Medicaid Provider Revalidation

All enrolled New Hampshire Medicaid providers - both individuals and groups - must revalidate their enrollment information every five years, in accordance with Section 6401 of the Affordable Care Act. NH Medicaid providers were reenrolled beginning in the spring of 2012 in preparation for the new MMIS-Health Enterprise System. Therefore New Hampshire’s 5-year revalidation started in June of 2017. Providers will be due to revalidate their information no later than five years from their enrollment date with New Hampshire Medicaid.

The provider revalidation process will be conducted exclusively online through the MMIS Portal. When it is time to revalidate your enrollment information, you will receive a revalidation notice through the mail and it will also be posted on your MMIS Message Board. The MMIS Portal will not allow a provider to begin their revalidation until their provider number has been selected for revalidation.

Providers will have 60 days from the date of the revalidation letter to complete and submit their provider revalidation. Call the NH Medicaid Provider Call Center if you have questions while doing your Revalidation: 866-291-1674

Is any documentation required with Revalidation?

The only document needed with Revalidation is the Signature Page, which must be uploaded before submitting your Revalidation. For instructions, please read How to Upload Signature Page Adobe Acrobat Reader Symbol.

Do you have current MMIS login credentials?

It is critical that providers keep their MMIS login credentials current. If a current user has not logged into their MMIS account for 30 days, the user will get a message that their account is inactive. The user has to call the NH Provider Call Center at 866-291-1674 to activate their account. If the user has not logged into MMIS for 90+ days, the system will drop the user ID because of inactivity and the provider has to complete the NH MMIS Health Enterprise Portal Registration Form Adobe Acrobat Reader Symbol and either mail or email it to the address at bottom of form or fax the form to 866-446-3318.

Additional Resources

For a step-by-step guide on Revalidation, please see the Provider Revalidation Presentation Adobe Acrobat Reader Symbol.

For more information, please read the Provider Revalidation FAQs Adobe Acrobat Reader Symbol

General Information for Providers

All providers of NH Medicaid covered services must enroll with the state as a NH Medicaid provider to bill medical or pharmacy claims for NH Medicaid recipients. To enroll as a provider, go to and click on Provider in the upper left of the page, then click on Enrollment to open the online enrollment application. Providers who intend to only provide services to NH Medicaid’s fee-for-service recipients only need to enroll with the state. Providers who want to provider services for members in one or all of NH Medicaid’s Managed Care Organizations (MCO) must first enroll with the state, then contract and credential with the MCOs.

If you have questions on prescription drug coverage and clinical prior authorizations please visit Magellan's website at:

340B covered entities, except for DHHS-approved family planning providers, should not bill NH Medicaid for drugs purchased through the 340B program.

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