How to Enroll Online as an Individual Billing Provider

You can complete the NH MMIS Health Enterprise Portal online pages to enroll as an individual billing provider. An individual billing provider is a provider that reports income to the Internal Revenue Service through a Social Security number. If you are already enrolled as a New Hampshire Medicaid provider, you also can complete the online pages to enroll another service location.

Optionally, you can:

• Delete information. To delete information from a record, in the table, click the appropriate row and on the panel's action bar, click Delete.
• Save the application. To complete the application at a later time, click Save.
• Exit the application. To exit the application without saving your changes, click Exit Application.
• Reset your entries. To clear the fields and remain on the page or panel, click Reset.
• Cancel your entries. To close the page or panel without saving your changes, click Cancel.

To enroll as an individual billing provider

1. Do one of the following:
   • On the Provider menu, click Enrollment.
   • On the Quick Links pod on the public Home page, click Enrollment.

The Provider Enrollment page is displayed.

2. In the Become a Billing Provider panel, click Individual Billing Provider Enrollment.

   The Individual Billing Provider Enrollment Instructions page is displayed.

3. Read the instructions, and click Continue.

   The first of several online enrollment pages is displayed.

4. To page through and complete the following enrollment pages, click Continue:
• Identifying Information
• Licensure / Certification
• Provider Identifier Number
• Service
• Group Affiliation
• Electronic Claims Submission
• Ownership
• Exclusion/Sanction

Tip: To complete or submit an application at a later time, click Save.

Warning: All entered information is lost if you choose to exit the application before saving.

Note: On the Service Page, you have the option of enrolling in Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA).


5. At the end of the application pages, on the Submit Application Step 1 page, read the instructions carefully and click Yes or No to indicate if you wish to have Web access for this service location. If Yes, enter your administrator's information.

Note: Web access allows you to submit claims electronically, and creates an online message center where you can receive messages and remittance advice.

6. To check your application for errors, click Validate Application and resolve any issues.

   The Submit Application Step 2 page is displayed if there are no errors.

7. Optionally, to add another service location, on the Submit Application Step 2 page, do the following:

   1. Click Add Another Service Location.

   2. On the following pages, complete the fields, and then click Continue to proceed to the next page.

      • Identifying Information
      • Licensure / Certification
      • Provider Identifier Number
      • Service
      • Group Affiliation

   3. On the Submit Application Step 1 page, read the instructions carefully and click Yes or No to indicate if you wish to have Web access for this service location. If Yes, enter the administrator's information.

      Note: Web access allows you to submit claims electronically, and creates an online message center where you can receive messages and remittance advice.

   4. Click Validate Application and research and address any duplicate issues listed in the Duplicate Data table. Multiple service locations for a provider will appear in the table as possible duplicates and can be overridden.

8. Optionally, to edit a service location, on the Submit Application Step 2 page, do the following:

   1. Click Edit Service Location.
   2. In the Service Locations table, click the appropriate row.

   3. On the Service page, complete the fields and navigate to any of the other pages as needed.

      • Service
      • Identifying Information
      • Licensure/Certification
      • Provider Identifier Number
      • Group Affiliation
   4. If needed, on the Submit Application Step 1 page, edit the administrator's information for this service location.
   5. Click Validate Application and research and address any duplicate issues listed in the Duplicate Data table. Multiple service locations for a provider will appear in the table as possible duplicates and can be overridden.

9. Optionally, to go back and edit the application before you submit it, on the Submit Application Step 2, do the following:

   1. Click Edit Application.
   2. Starting from Step 4, edit the application as needed.

10. To submit the application, on the Submit Application Step 2 page, click Confirm Submit.

    Tip: All required fields must be entered for all locations associated to this application before the submission can occur. After you submit your application, you cannot recall it to change or add information at a later date. Your enrollment application information is submitted to New Hampshire for approval.

    The Submit Complete page is displayed.

11. If you submitted the application, on the Submit Complete page, you must also do the following:
    • Record your application tracking number, including the trading partner application number, if applicable.
    • Print the required documents, such as Provider Enrollment Signature, Medicaid Provider Participation Agreement, and Document Requirement Checklist. If you signed up to send or receive transactions or remittance advice electronically, then print the Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) documents.
    • Sign the required documents.
    • Send in all signed and required additional documents to the address provided.
    • To print a copy of the enrollment application you just completed, click Print Application.
    • To exit the application form, click Exit Application.

What's Next?

Individual providers can optionally enroll as a group provider.

See Also