Medicaid Provider Relations

Providers of NH Medicaid covered services must enroll with the state to bill medical or pharmacy claims for NH Medicaid recipients. To see a list of covered services, visit the Medicaid page. 

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. Click on Enrollment to open the online enrollment application.

  • Providers who intend to only provide services to NH Medicaid Fee for Service recipients need to only enroll with the state.
  • Providers who want to provide services to members enrolled in Medicaid Care Management must first enroll with the state, then contract and credential with the health plan(s).

Ordering, Referring, Prescribing (ORP) 

Non-billing providers who order, refer, or prescribe supplies, services and/or pharmaceuticals for NH Medicaid beneficiaries in the state’s Medicaid Fee for Service (FFS) program must enroll with NH Medicaid. This requirement also applies to medical and dental providers who write prescriptions. 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 an online application for all non-billing providers: rendering or ORP. This shortened enrollment application is available on the MMIS online portal.

The ORP Federal regulation only applies to Medicaid FFS. The ORP enrollment requirement does not apply to providers listed on claims submitted to the health plans. For questions related to Medicaid Care Management, refer to your provider contract and the health plan enrollment and claims processing requirements.

Checking Eligibility for Medicaid Recipients

It is important that providers check and confirm eligibility and health plan enrollment prior to providing services to Medicaid recipients. MMIS is the software system that maintains eligibility information for all NH Medicaid recipients. If providers have questions after checking the MMIS online portal, please contact the state’s Medicaid Provider Service Center at 1-866-291-1674.

 

NH Medicaid Services

Pharmacy Benefit

If you have questions on prescription drug coverage and/or pharmacy prior authorizations, please visit Magellan's website or the Medicaid Pharmacy Benefit Management page. 340B covered entities, except for DHHS-approved family planning providers, should not bill NH Medicaid for drugs purchased through the 340B program. For questions related to Medicaid Care Management prescription drug coverage and/or pharmacy prior authorizations, refer to your provider agreement or visit the health plan's website.

Medicaid Fee for Service

The Medicaid Fee for Service Authorization program is designed to provide service authorizations to providers for medical services to Fee for Service recipients. Service authorization requirements are based on Administrative Rules set by the legislature. A guide to the service authorization process can be found in the He-W 500 rule.

A service authorization approval is a determination that the services requested are medically necessary and cost effective in obtaining measurable, realistic goals for the individual. It is not a guarantee of payment. Service authorization requests for Medicaid Fee for Service recipients can be found on the MMIS online portal.  All service authorizations should be submitted via secure email at ServiceAuthorizationFFS@dhhs.nh.gov. For questions related to Medicaid Care Management service authorizations, contact your health plan provider representative or visit the health plan's website.

NH Medicaid Provider Revalidation FAQs

What is provider revalidation?

All enrolled NH Medicaid providers must revalidate their enrollment criteria every five years in accordance with Section 6401 of the Affordable Care Act. These regulations were published in the Federal Register, Vol. 76, February 2, 2011, and were effective March 25, 2011.

Do other states have provider revalidation?

Yes, all 50 states have been mandated to perform provider revalidation.

I am a Medicare provider who has revalidated with Medicare. Do I need to revalidate with New Hampshire Medicaid?

Yes, you must revalidate with NH Medicaid.

I am an out-of-state New Hampshire Medicaid provider and I have already revalidated with my home state. Do I need to revalidate with NH Medicaid?

Yes, you must revalidate with NH Medicaid.

I have already re-credentialed with one of New Hampshire Medicaid’s Health Plans. Do I need to revalidate with New Hampshire Medicaid?

Yes, you must revalidate with NH Medicaid.

How will I know that I need to begin the provider revalidation process?

When it is time to revalidate your enrollment as a provider, you will receive a revalidation notification letter in the mail and it will also be posted in your message center on the MMIS portal.

I am an individual provider. Do I have to revalidate for each group with whom I am affiliated?

No, an individual provider only completes one revalidation per individual provider number.

How do I complete the provider revalidation process?

The provider revalidation application is available exclusively online. When it is time to revalidate your enrollment as a provider, you will receive a revalidation notification letter in the mail and it will be posted in your message center on the MMIS portal. Providers will log in to the NH MMIS provider portal and click the revalidation link. The system will guide you through the revalidation process.

How do I complete revalidation if I don’t have internet access?

Providers without internet access should ask for alternate arrangements by calling the Medicaid Provider Call Center at (866) 291-1674 or (603) 223-4774.

How long do I have to complete the revalidation process?

You have 60 days from the date of the first revalidation notification to complete and submit the provider revalidation application in its entirety, with all current information.

I have multiple NH Medicaid ID numbers. Do I have to do a separate revalidation for each of my NH Medicaid ID #s?

Yes, a provider is required to complete revalidation for each of their NH Medicaid ID#s.

Can I do the revalidations for my multiple NH Medicaid ID#s at one time?

No, providers can only revalidate upon receipt of the Revalidation Due letter. The letters are generated based on the date of each ID’s original enrollment. All revalidations are due approximately 5 years from date of enrollment with the MMIS-Health Enterprise System.

I’m concerned about entering my social security number or other identifying information on the provider revalidation website. Is the website secure?

Yes, the website is secure. NH Medicaid’s MMIS uses the national standard in website security software to ensure that the information entered onto the site is secure.

Can I save my provider revalidation application and return to it later?

Yes. There are certain points that are clearly defined in the provider revalidation process where one can save their work and exit the application. When ready to return to one’s revalidation questions, the user logs back into the MMIS portal and clicks on the revalidation link.

Will I need a site visit?

All moderate and high risk providers must have a site visit. But if a provider has had a site visit done by Medicare within the past 5 years, the provider does not need a site visit for NH Medicaid Revalidation. If you are unsure if you will be required to have a site visit for revalidation, please contact the DHHS Program Integrity Unit at (603) 271-8029.

Can I request an extension?

No. Extensions will not be granted due to the stringent timelines mandated by Federal Regulation 42 CFR 455.104(c) and 42 CFR 455.450.

How will I know that my provider revalidation is complete?

When the provider has entered all of their updates and reached the end of the data that needs to be validated, the signature section is displayed. There is a print button that must be clicked to print the signature page. The provider signs the printed signature page and then uploads it via the upload signature page option. Once the signature page is uploaded, the confirm button appears. When the provider clicks confirm submit, a message displays that the application has been submitted. A provider will then get a letter stating that their revalidation has been received.

What happens if I fail to revalidate?

Providers who do not revalidate will be terminated with NH Medicaid Fee for Service, and subsequently with the Medicaid health plans. 

Where can I get more information about revalidation?

The Provider Revalidation link under the MMIS Portal’s Quick Links will have up-to-date information, with the most recent post at the beginning of the page.

Does a provider need their MMIS login credentials to complete the revalidation?

Yes, a provider must have current login credentials. If a provider has not logged into MMIS for 30 days, the user will get a message that their account is inactive. The user has to call the NH Provider Call Center to activate their account. If the user has not logged in for 90+ days, the system will drop their user ID because of inactivity. To reactivate an MMIS provider account, go to nhmmis.nh.gov, click on Documents and Forms, and scroll down to the NH MMIS Health Enterprise Portal Registration Form. Print and complete the form, and either mail it to the address at the bottom of the form or fax the form to 1-866-446-3318.

Contact Information