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Preventing and Resolving Claim Denials

Date: 03/06/17

NH Healthy Families wants to remind providers of the health plan’s filing limit requirements and the process to have claim payment concerns reviewed.

The NH Healthy Families Provider Billing Manual describes general billing and claim submission guidelines. Please visit our website at NHHealthyFamilies.com for the complete Provider Billing Manual.

Timely Filing Guidelines:

  • NH Healthy Families (NHHF) reminds providers that best efforts should be made to submit first time claims within 180 days of the date of service; however, claims will not be accepted for payment after 365 days from the date of service.
  • When NH Healthy Families is the secondary payer, the claims must be received within 365 days from the date of disposition (final determination) of the primary payer. Claims received outside of this timeframe will be denied for untimely submission

Claim Requests for Reconsideration, Claim Disputes, or Corrected Claims:

All reconsideration, disputes, and corrected claims must be submitted within 180 days from the original date of notification of payment or denial but not to exceed 15 months from the original date of service.

If a provider has a question or is not satisfied with the information s/he has received related to a claim, there are five ways in which the provider can contact NH Healthy Families:

1. Review the claim in question in the secure Provider Portal

2. Contact Provider Services at 1-866-769-3085

3. Submit an Adjusted or Corrected Claim to NHHF (did you know you can submit a corrected claim through the Provider Secure Portal?)

 4. Submit a “Request for Reconsideration” to NH Healthy Families: (Attn: Claims Dept, P.O. Box 4060 Farmington, MO 63640-3831)

5. Submit a “Claim Dispute Form” to NH Healthy Families: (Attn: Claims Dispute, P.O. Box 3000 Farmington, MO 63640-3800)

If your submission does not meet the above timeline, NH Healthy Families will deny your request as not meeting timely filing guidelines. Please refer to the NH Healthy Families’ Provider Billing Manual for detailed information on submitting claim disputes, reconsiderations, corrected claims or viewing claims in the secure provider portal.

Need further assistance? Reach out to your Provider Network Specialist or contact the Provider Relations Team at nhproviderrelations@centene.com.