Provider Claims Tools

Navigating NH Healthy Families Claims and Payment

The NH Healthy Families Claims and Payment Decision Tree can help guide you through some common claims and payment-related issues. Within this document, you’ll find the steps you’ll need to take if:

  • Your claim was denied 
  • You are awaiting payment for a submitted claim
  • You have a question about how your claim processed 
  • You’ve noticed a concerning trend in your claim denials/payments
  • You want a progress update on an existing claim issue 

Download a copy of the Claims and Payment Decision Tree (PDF)

Claims and Payment Information

For more information, please see our Billing Tip Sheets (under Guides), Provider Manual (PDF) and/or Billing Manual (PDF)

Claims Reconsiderations and Disputes

A Request for Reconsideration (Level I) is a communication from a provider about a disagreement with the manner in which a claim was processed. A Reconsideration can be submitted to NH Healthy Families via the Provider Portal, or by mailing a completed Request for Claim Review form to the address listed on the form. A Claim Dispute (Level II) should be used only when a provider has received an unsatisfactory response to a Request for Reconsideration.

Claims Trend Identification

Have you noticed an underlying or ongoing issue that is impacting 10+ of your practice’s NH Healthy Families claims? Instead of digging through your records to identify all potentially impacted claims, you can alert us to the issue by providing one example claim and a brief description of the trend you are seeing.

If you do identify a claims trend issue, please fill out the Claims Trend Reporting Requirements PDF below, and then return it to NHProviderRelations@CENTENE.COM.

NH Healthy Families Payment Policies

  • All NH Healthy Families Payment Policies, which are used to help identify whether health care services are correctly coded for reimbursement, can be found on our Clinical & Payment Policies Page.