Frequently Asked Questions for Providers

Is nonemergent medical transportation (NEMT) covered?

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.

Is dental covered?

Dental is an extra benefit for adult members (21 and older). The benefit covers preventive services (cleaning), diagnostic services (exams and X-rays), restorative services (fillings), and some periodontal services (root planing and scaling).

Does AmeriHealth Caritas New Hampshire provide interpretation and translation services?

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).

How do I get paid and how long do I have to wait for payment?

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.

What are the timely filing deadlines? Does the timely filing limit of 120 days apply to both participating and nonparticipating providers?

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).

If Medicaid is the secondary payer, will Medicare cross the claim over to us?

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.

Should I hold claims until I know that we are in network?

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.

Is billing of behavioral health services restricted by specialty?

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

Where can I obtain a contract?

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

How long will it take to be credentialed or in network?

Providers are typically notified within 30 business days.

How can I check on my status while going through credentialing?

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

Do providers need a New Hampshire MAID number?

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.

How can I verify member eligibility and benefits?

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.

How timely will eligibility be sent from the state to AmeriHealth Caritas New Hampshire?

The state sends eligibility files daily.

How is continuity of care managed?

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).

How can I find out who my network Account Executive is?

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.

Will members be required to select a primary care physician (PCP)?

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.

How does a member change his or her PCP?

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.

Are there pharmacy copays?

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

Do specialty drugs require prior authorization?

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

Is there a formulary?

Yes. See our online formulary.

How do I obtain prior authorization?

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.

Who is your radiology vendor?

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

Do certain diagnostic services require authorization?

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.

Do Medicaid patients need a referral?

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

How can I obtain a copy of the fee schedule?

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

Is training available on how to use NaviNet?

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.