Frequently Asked Questions for Providers

Yes. AmeriHealth Caritas New Hampshire contracts with Coordinated Transportation Solutions (CTS) for NEMT and mileage reimbursement. Members who have a car, or a friend or family member with a car, to drive to medically necessary services, must use the Family and Friends Mileage Reimbursement program. If no car is available, CTS will arrange NEMT for members via the most cost-effective and least expensive mode of transportation available. Whether they are using the mileage reimbursement program or having CTS arrange other transportation, members must contact CTS in advance of their appointment at 1-833-301-2264.

Yes, interpretation and translation, and services for the hearing and visually impaired are provided at no cost to AmeriHealth Caritas New Hampshire members. Contact AmeriHealth Caritas New Hampshire Member Services at 1-833-704-1177 (TTY 1-855-534-6730).

We encourage our providers to sign up for electronic funds transfer (EFT). If you would like to sign up for EFT, contact Change Healthcare at 1-877-363-3666. If you do not sign up for EFT, you will receive payment by a check in the mail.

Initial claim: within 120 days of the service date, except in situations regarding coordination of benefits. Rejected claims: within 120 days of service date. Corrected claims: resubmitted within 365 days of service date. Timely filing applies to both participating and nonparticipating providers. For a detailed explanation of timely filing, please refer to the claims filing instructions (PDF).

Yes, we will accept claims directly from Medicare when we are the secondary payer. If the primary payer does not cross over the claim to AmeriHealth Caritas New Hampshire, providers should submit secondary claims to AmeriHealth Caritas New Hampshire with the Explanation of Benefits (EOB) from the primary payer within 60 days of the date on the EOB. We will accept third-party liability (TPL) claims with the primary insurer EOB electronically or via paper submission.

No, please send claims as soon as possible. Timely filing limits are 120 calendar days from the date of service. If in doubt of your participation status at the time of service, call Credentialing at 1-866-610-2770.

Yes, providers can only be reimbursed for services within the scope of their license.

By phone at 1‑888‑599‑1479 or by email at newhampshireprovidernetwork@amerihealthcaritas.com.

Providers are typically notified within 30 business days.

You may contact the Credentialing department at 1-866-610-2770.

Unless otherwise indicated, providers participating with AmeriHealth Caritas New Hampshire must be enrolled in New Hampshire Medicaid and have a New Hampshire Medicaid identification number and unique National Provider Identifier (NPI) for every provider type.

There are several ways to verify eligibility and benefits: Logon to our secure provider portal via NaviNet, call AmeriHealth Caritas New Hampshire Provider Services at 1-888-599-1479, use electronic data interchange (EDI) eligibility verification transactions available from your clearinghouse or practice management system, visit the New Hampshire Medicaid Management Information System (MMIS) Health Enterprise Portal at nhmmis.nh.gov/portals, or ask to see the member’s plan ID card.

The state sends eligibility files daily.

If you have a member who has an existing authorized service, AmeriHealth Caritas New Hampshire will honor the authorization. For more information, please refer to the provider manual (PDF).

A dedicated Account Executive will be assigned to your practice. If you have questions, or are unsure of whom your account executive is, call Provider Services at 1-888-599-1479.

Upon enrollment with AmeriHealth Caritas New Hampshire, members are encouraged to select a PCP from a list of participating providers. After 14 days, if the member fails to select a PCP, they will be auto-assigned.

Members can change their PCP by contacting Member Services. The provider office can call Member Services with the member present to request the change, but the member must give their approval for the change. A member may also download and complete the Primary Care Provider Selection Form (PDF) and fax it to Member Services at 1-833-243-2264.

AmeriHealth Caritas New Hampshire follows New Hampshire Department of Health and Human Services guidelines for pharmacy copayments. Preferred or approved nonpreferred prescription drugs are $1 per prescription or refill

Yes, all specialty drugs require prior authorization. Please refer to the New Hampshire Medicaid preferred drug list (PDL) (PDF).

Yes. See our online formulary.

Prior authorization can be obtained three ways:

• By form: Providers may need to complete a form before administering some health services to members. The form can be found under Forms, and faxed to 1-833-469-2264.
• By phone: Call our Utilization Management department at 1-833-472-2264.
• By provider portal: Log on to NaviNet to access our online prior authorization management system.

National Imaging Associates (NIA) provides utilization management review and authorization for nonemergent, advanced, outpatient imaging procedures.

Yes, AmeriHealth Caritas New Hampshire's radiology benefits vendor, National Imaging Associates, Inc. (NIA), provides utilization management review and authorization for nonemergent, advanced, outpatient imaging procedures: Services managed and authorized by NIA include outpatient:

• CT scan.
• MRI/MRA.
• PET scan.
• Nuclear cardiac imaging.

Please contact NIA at www.radmd.com or 1-800-424-4784.

Referrals are not needed if the provider is in our network and the patient is an AmeriHealth Caritas New Hampshire member.

You can access the fee schedule at the New Hampshire MMIS Health Enterprise Portal

Yes. To request training on NaviNet, please contact NaviNet through the link on our website or directly on NaviNet's website. There are helpful guides on the NaviNet website under “resources.” Your Account Executive can also assist.