Provider Claims Tools
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)
- For claims mailing instructions and more information refer to our Additional Information to Support Claims Correction (PDF)
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.
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.
- 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.
In an effort to streamline the claims process, we have created a number of guidelines and tip sheets on important topics.
- Billing Guidelines for Newborn Babies (PDF)
- CLIA Billing Tip Sheet (PDF)
- Coding Tips Flier (PDF)
- Coordination of Benefits Policy (PDF)
- Critical Access Hospital Billing Tip Sheet (PDF)
- Diabetes Coding Tip Sheet (PDF)
- Hospital Based Rural Health Clinic Billing Tip Sheet (PDF)
- Negative Balance Tip Sheet (PDF)
- Preventing and Resolving Claim Denials Important Reminders (PDF)
- Vaccine and Immunization Administration Billing Guidelines (PDF)