Provider Enrollment   Skip portlet
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Become a Provider
If you would like to become a Provider for the New Hampshire Title XIX Program, you can do so by completing an application on line, or completing a paper application that can be downloaded here or sent to you through the Mail. If you are applying with a Federal Employer Identification Number (FEIN), please complete and submit the Group Provider Enrollment Application. If you have any questions regarding the application process, please contact ACS Provider Enrollment at (603) 223-4774 or (866) 291-1674 during business office hours from Monday to Friday, 8 am - 5 pm EST.
Group Provider Enrollment
Become a Trading Partner
If you would like to become a Trading Partner (EDI) to exchange business information electronically with the New Hampshire Title XIX Program, you can do so by completing an application on line. If you have any questions regarding the application process, please contact ACS Provider Enrollment at (603) 223-4774 or (866) 291-1674 during business office hours from Monday to Friday, 8am -5pm EST.
Application Status
To check the status of your New Hampshire Title XIX Program Provider or Trading Partner Application, use your Application Tracking # and click the SUBMIT button.
  
Recall Provider Application
To recall an application that you have partially completed, enter your Application Tracking Number, and SSN / FEIN and click the SUBMIT button.




Recall Trading Partner Application
To recall an application that you have partially completed, enter your Application Tracking Number and SSN / FEIN and click the SUBMIT button.