Trading Partner Enrollment (Submit Complete) Page

You receive the Submit Complete page when you have submitted your application successfully. It provides a trading partner application tracking number to be used when you are checking on the status of your application. You can print any required documents from this page. All signed enrollment documents and additional information can be sent to the address indicated.

The Submit Complete page contains the following panels:

Application Tracking Number
Print, Sign, and Send in your application

Application Tracking Number Fields

Field	Description
Application Tracking Number	Number assigned to your trading partner application. It is required when you check the status of your application by phone or via the Web. It should also be written on all documents that are mailed in to support your application.

Print, Sign, and Send in Your Application Fields

Links	Description
Print Required Document Print, complete, and mail the document listed to the address indicated on the page. The list of documents depends on the type of application being submitted. Please put the Application Tracking Number on all documents that are being mailed in to support your application. The following is an example of a commonly required document.
Trading Partner Enrollment Signature Agreement	Agrees that the organization (provider that is also a trading partner, or just trading partner) will abide by all federal regulations when sending/receiving electronic transactions to/from the NH MMIS. Only original signatures are accepted.
To print a copy of the entire application you entered for your records, click Print Application. To exit the application and return to the Provider Enrollment Home page, click Exit Application.

Links

Description

Print Required Document

Print, complete, and mail the document listed to the address indicated on the page. The list of documents depends on the type of application being submitted. Please put the Application Tracking Number on all documents that are being mailed in to support your application. The following is an example of a commonly required document.

Trading Partner Enrollment Signature Agreement

Agrees that the organization (provider that is also a trading partner, or just trading partner) will abide by all federal regulations when sending/receiving electronic transactions to/from the NH MMIS. Only original signatures are accepted.

To print a copy of the entire application you entered for your records, click Print Application.

To exit the application and return to the Provider Enrollment Home page, click Exit Application.