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Click ‘Get Form’ to open the nh caritas form in the editor.
Begin with Section 1 by entering the facility name and selecting the appropriate facility type. Ensure all fields are completed accurately.
Provide primary contact details, including name, email, and phone number. Fill in the billing type as either UB-04/institutional or CMS-1500/professional.
In Section 2, list all locations and complete required information such as TIN/EIN, NPI, and Medicaid ID. Use additional copies if necessary for multiple locations.
Proceed to Section 3 to check all applicable services provided at each location. Utilize the notes column for any special instructions related to services.
Finally, complete Section 4 by detailing practitioner information including licensures and whether they are accepting new patients.
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Call AmeriHealth Caritas New Hampshire Member Services, 24 hours a day, seven days a week, at 1-833-704-1177 (TTY 1-855-534-6730).
What is NH Medicaid called?
To participate in NH Medicaid (Medical Assistance), federal law requires the Department to cover certain groups of individuals. Low-income families, qualified pregnant women and children, and individuals receiving Supplemental Security Income (SSI) are examples of mandatory eligibility groups.
What type of insurance is AmeriHealth Caritas NH?
For more than 35 years as a Medicaid managed care program, we? ve been committed to helping members get care, stay well, and build healthy communities.
How do I contact NH Medicaid?
Contact the DHHS Customer Service Center toll-free at 1-844-ASK-DHHS (1-844-275-3447) (TDD Relay Access: 1-800-735-2964), Monday through Friday, 8:00 a.m. to 4:00 p.m. ET.
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Resource Guide for Consumers: How to Access Mental Health
by LC Hodder 2023 An appeal request form is also available through NH DHHS AAU. NH Healthy Families and AmeriHealth Caritas. New Hampshire) and the Granite Advantage Program.
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