New Hampshire Medicaid Billing Agent Agreement

This document is a guide for the New Hampshire Medicaid Billing Agent Agreement process. It outlines the requirements for providers who utilize a billing agent or clearinghouse. Providers must print and sign the Billing Agent Agreement, ensuring that only original signatures are submitted, as copied or stamped signatures are not accepted. The guide specifies that providers should check 'Yes' in the Third Party Billing segment of Section 4 and complete the Billing Agent/Clearinghouse segment in Section 6. It also details the necessary information to include, such as the NH Medicaid ID, Provider Name, and requested transactions (837 and/or 835). Additionally, it provides instructions for mailing the agreement to NH Medicaid Provider Relations and notes that the standard processing time is approximately 7-10 business days. Contact information for NH Medicaid Provider Enrollment is included for further inquiries.