Manuals, Forms and Resources

Manuals

• New Hampshire Healthy Families Provider Manual
• New Hampshire Healthy Families Billing Manual
• NH Healthy Families Cenpatico Provider Manual
• Pharmacy – US Script - Provider Manual
• Total Vision Provider Manual
• Transportation Provider Manual

Guides

• HEDIS - Adult
• HEDIS – Pediatric
• HEDIS – Woman
• Provider Benefit Overview – EPDST
• PaySpan
• Plan Guide
• Prior Authorization
• Claims Billing Aid
• PT/OT/ST Medical Necessity Guidelines
• New Hampshire Healthy Families Contact Information

Forms

• Claim Dispute Form
• Claim Adjustment Request Form
• Provider Explanation of Payment (EOP) Request Form
• MemberConnections Referral
• Notification of Pregnancy Form
• Prenatal Vitamin Form
• Prior Authorization – Inpatient
• Prior Authorization - Outpatient
• PCP Change Form
• Provider Change Form
• Prior Authorization Request Form, PT/OT/ST
• Provider Status Change Form
• Provider Reconsideration Request Form
• Transportation Reimbursement Form

Resources

• Provider Quick Reference Guide
• Provider Relations Territory Map
• PT/OT/ST Provider QRPG
• 2014 Provider Satisfaction Report

Presentations

• Provider Orientation Presentation
• NIA Provider Orientation
• Prior Authorization Training, Outpatient, PT/OT/ST
• Medical Multi-Line Authorizations on the Secure Provider Website

Ambetter Manuals & Forms

For Ambetter information, please visit our Ambetter website.