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NH Medicaid Provider Information

NH Medicaid providers must begin using ICD-10 codes on October 1, 2015

The International Classification of Diseases, Tenth Edition (ICD-10) is a system of diagnosis codes and other codes that U.S. healthcare providers will begin using on October 1, 2015. The transition to ICD-10 is required for everyone covered by the Health Insurance Portability Accountability Act (HIPAA).

The change to ICD-10 does not affect CPT coding for outpatient procedures and physician services.

The date of service drives whether a provider needs to use an ICD-9 or an ICD-10 code on their claim. For dates of service through 9/30/15, an ICD-9 code must be used. For dates of service on or after 10/1/15, an ICD-10 code must be used. For inpatient claims, the date of discharge determines which code set to use.

Please visit the ICD-10 Resources section of the NH MMIS Health Enterprise portal, using the link below. Resources include an overview, listing of websites with ICD-10 information, FAQs, and 2 Computer-Based Training Modules for NH Medicaid providers.

General Information for Providers

All providers of NH Medicaid covered services must be enrolled as a NH Medicaid provider with Xerox to bill medical or pharmacy claims for NH Medicaid recipients. You can contact Xerox via their website or call them at 1-866-291-1674 or (603) 223-4774 to become an enrolled provider.

If you have questions on if a NH Medicaid covered service requires a prior authorization (PA) please visit Xerox's website and select downloads to obtain all prior authorization forms for services.

If you have questions on prescription drug coverage and clinical prior authorizations please visit Magellan's website at:
To check eligibility for a NH Medicaid recipient please call 1-866-291-1674 and follow the prompts.

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New Hampshire Department of Health and Human Services
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