Section He-C 6339.08 - Billing Process for Community-Based In-Home Services(a) Prior to service delivery, a provider shall obtain an authorization form, which consists of one of the following: (1) For medicaid eligible recipients, a "New Hampshire Title XIX Medicaid Program Service Authorization" from the New Hampshire Medicaid fiscal agent or(2) For non-medicaid eligible recipients, a Form 2110 "Service Authorization" (6/30/2008) .(b) A provider shall bill the NH medicaid fiscal agent for medicaid eligible recipients either via paper claims or electronic claims submission, following the directions outlined by the NH medicaid fiscal agent, as follows: (1) For a paper claim submission, a provider shall complete a CMS 1500 form and mail it to the NH medicaid fiscal agent; or(2) For electronic claim submission, a provider shall submit an electronic claim to the NH medicaid fiscal agent.(c) A provider shall bill the department through NH Bridges for non-medicaid eligible recipients either via paper claims or electronic claims submission, as specified in (d) and (e) below.(d) For paper claim submissions for all services, a provider shall: (1) Copy the Form 2110 "Service Authorization" 6/30/2008) for future billings, if the authorized service dates span a date range;(2) Complete and submit a copy of the Form 2110 "Service Authorization" (6/30/2008) to the department;(e) For electronic claim submissions, a provider shall: (1) Request a web billing account from DHHS by completing, signing, and submitting Form 2679 "Provider Web Billing User Account Request Form" (October 2016);(2) Be issued a log on and personal identification number (PIN) by DHHS for use in accessing the web billing account; and(3) Neither the provider nor any authorized representative shall transfer his or her log on or PIN, or allow use of his or her log on or PIN by any other person.N.H. Admin. Code § He-C 6339.08
(See Revision Note at part heading for He-C 6339) #9263, eff 9-20-08
Amended by Volume XXXVI Number 41, Filed October 13, 2016, Proposed by #11180, Effective 9/19/2016, Expires 3/18/2017.Amended by Volume XXXVII Number 15, Filed April 13, 2017, Proposed by #12136, Effective 3/18/2017, Expires 3/18/2027.