Trading Partner Enrollment (Submit Application Step 1) Page

You use the Submit Application Step 1 page to validate your application as a trading partner. If you are a billing agent, clearinghouse, switch vendor, or carrier, you also add and edit the information about your selected organization administrator. The organization administrator is the primary Web portal user for the organization and can create new user IDs as needed for staff to access the organization’s information in NH MMIS Health Enterprise Portal.

Trading Partner Enrollment - Submit Application Step 1 Fields

Field Description
If you are a trading partner classified as Provider/Self, these fields are not displayed. You only need to validate your application.
Organization Name

The name of the organization in which the trading partner's Organization Administrator resides.

Examples: ABC Insurance, ABC Billing Agency
Organization Description

Short description identifying the trading partner organization.

Examples: ABC Medical Systems, Hospitals and Urgent Cares Billing Agent
User ID

Enter the user ID the Trading Partner Administrator wants to use when logging on to the NH MMIS Health Enterprise Portal.

User IDs:

  • Are unique
  • Contain 6 to 16 alphanumeric characters
  • Contain no spaces

  • May contain one or more of the following special characters: hyphen (-), underscore (_), or period (.)

  • Conform to any other policies set by your organization
Prefix

The prefix you use with the organization administrator's name.

Examples: Mr., Ms., Mrs., Dr.
Last Name Last name of the person who is the trading partner's Organization Administrator.
First Name First name of the person who is the trading partner's Organization Administrator.
MI Middle initial of the person who is the trading partner's Organization Administrator.
Suffix Suffix of the person who is the trading partner's Organization Administrator.
Phone # The phone number of the person who is the trading partner's Organization Administrator.
Ext The extension of the phone number of the person who is the trading partner's Organization Administrator.
E-mail

The e-mail address of the person who is the trading partner's Organization Administrator. Required when a Trading Partner has selects Secured File Transfer Protocol (SFTP) as a transaction connection type on their application.
To check for errors on the application, click Validate Application. You must resolve any issues before submitting your application.