Medicaid Provider Relations

Information and resources for providers of NH Medicaid-covered services

New Hampshire Medicaid Provider Rate Increases

House Bill 2 (HB 2), of the 2023 Regular Legislative Session, appropriated funds to the Department for the purpose of increasing Medicaid rates. Please review the Medicaid Rate Informational Item for additional details on HB 2 appropriations. 

 

NH Medicaid Provider Enrollment

Please review the New Hampshire Medicaid Provider Enrollment Overview Guide for information on 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.

Screenshot of presentation opening slide

DHHS Client Authorization Forms

Training video for providers to assist clients in submitting authorization forms. 

Length: 14:55 | Transcript: DHHS Client Authorization Forms

NH Medicaid Services

Pharmacy Benefit

If you have questions on prescription drug coverage and/or pharmacy prior authorizations, please visit Prime Therapeutics 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.

All enrolled New Hampshire Medicaid providers--both individuals and groups--must revalidate their enrollment information every five years, in accordance with federal regulations. 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 their first revalidation letter to complete and submit their provider revalidation. A provider’s claims could be suspended if their Revalidation is not completed. Call the NH Medicaid Provider Call Center if you have questions while doing your Revalidation: 866- 291-1674.

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. Notices are sent to the mailing address that is currently listed on the Medicaid ID tied to that provider record in MMIS that is due for revalidation. You will receive notice 60 days prior, 30 days prior, and on the due date. 

Need to update an address? Please utilize our Change of Information Form. 

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 in the provider's MMIS portal account. When it is time to revalidate your enrollment as a provider, you will receive a revalidation notification letter in the mail. 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 must revalidate each Medicaid ID within each MMIS portal account. Each account due to revalidate will receive notice of the revalidation due date for that account. 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?

In the MMIS portal, the provider is presented with data elements from the original application that require verification. Once all data elements are verified or updated to reflect current information the provider will be presented with a signature section. The signature page section requires providers to click the print button, print the signature page, sign it and upload it back into the system using the upload signature page option. Once the signature page is uploaded, click the confirm button that appears. A message will display that the application has been submitted. You will also receive notification in the Provider Message Center: Provider Revalidation - For Your Records: Revalidation Data. You will receive another notification in the Provider Message Center: Provider Revalidation - Receipt of Your Revalidation, Thank You as well as a letter through the mail confirming completion of your revalidation once the State of New Hampshire has reviewed and accepted it.

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. If your provider enrollment is terminated with NH Medicaid, you may re-enroll by submitting a new application. A new Medicaid Provider ID will be assigned and you will need to re-enroll with the Managed Care Organizations (MCOs) as well.

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: Revalidation Overview. 

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. Users who have set up security questions will be able to reset their password, all other users will need to contact their Organizational Administrator (Org Admin) to reset their password or provide a new login. If you do not know your Org Admin or you are the Org Admin, call the NH Provider Call Center to re-activate your account.

If the user has not logged in for 90+ days, the system will drop their user ID because of inactivity and the provider will have to take the following steps to reactivate their MMIS provider account:

Go to nhmmis.gov, click on Documentation, click on Documents and Forms, and scroll down to the NH MMIS Health Enterprise Portal Registration Form. Print, complete the form, and either mail it to the address at the bottom of the form, fax the form to 866-446-3318, or send it in a secure email to NHProviderRelations@Conduent.com.

Contact Information

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