Provider Claims Tools

The Basics of Navigating NH Healthy Families Claims and Payment
Claims and Payment Information
Claims Reconsiderations and Disputes
Claims Trend Identification
NH Healthy Families Payment Policies
NH Healthy Families Claims Tip Sheets

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).

For claims mailing instructions and more information refer to our Additional Information to Support Claims Correction (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.

For fastest service, submit your Claims Reconsideration or Dispute via the Provider Portal.
Or, you can also complete and mail in the following form: Request for Claim Review Form (PDF)

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.

Claims Trend Reporting Requirements (PDF)

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.

NH Healthy Families Claims Guidelines and Tip Sheets

In an effort to streamline the claims process, we have created a number of guidelines and tip sheets on important topics.