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Contracted Provider Document Upload Form

What would you like to do? *
What kind of provider are you? *

Enroll a New Medical Practitioner

Have you attested on CAQH? *
Have you authorized NH Healthy Families in CAQH? *
Does your information in NPPES match the information on your enrollment request? *
How many practitioners are in your practice? *
Do you have or have you applied for a NH Medicaid ID? *

Enroll a New Behavioral Health Practitioner

Have you attested on CAQH? *
Have you authorized NH Healthy Families in CAQH? *
Does your information in NPPES match the information on your enrollment request? *
How many practitioners are in your practice? *
Do you have or have you applied for a NH Medicaid ID? *

Enroll a New Dual Practitioner

Have you attested on CAQH? *
Have you authorized NH Healthy Families in CAQH? *
Does your information in NPPES match the information on your enrollment request? *
How many practitioners are in your practice? *
Do you have or have you applied for a NH Medicaid ID? *

Update a Medical Practitioner or Practice

Does your information in NPPES match the information on your enrollment request? *

Update a Behavioral Health Practitioner or Practice

Does your information in NPPES match the information on your enrollment request? *

Update a Dual Practitioner or Practice

Does your information in NPPES match the information on your enrollment request? *