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This document serves as an enrollment registration form for providers wishing to participate in the New Hampshire Medicaid Dental Electronic Remittance Advice (ERA) program. It outlines necessary
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How to fill out New Hampshire Medicaid Dental Electronic Remittance Advice (ERA) Enrollment Registration
01
Obtain the New Hampshire Medicaid Dental Electronic Remittance Advice (ERA) Enrollment Registration form from the official website or your local Medicaid office.
02
Fill in the provider's information, including the name, address, and NPI number.
03
Indicate the type of services provided by checking the appropriate boxes.
04
Provide your contact information, including phone number and email address.
05
Review the terms and conditions for enrolling in the ERA program and ensure you understand them.
06
Sign and date the form to validate your enrollment request.
07
Submit the completed form to the designated Medicaid office via email or postal service, as instructed.
Who needs New Hampshire Medicaid Dental Electronic Remittance Advice (ERA) Enrollment Registration?
01
Dental providers enrolled in the New Hampshire Medicaid program who wish to receive electronic remittance advices for their claims.
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What is New Hampshire Medicaid Dental Electronic Remittance Advice (ERA) Enrollment Registration?
New Hampshire Medicaid Dental Electronic Remittance Advice (ERA) Enrollment Registration is a process for dental providers to enroll in receiving electronic remittance advices, which provide details about claim payments and adjustments electronically, streamlining the billing and payment process.
Who is required to file New Hampshire Medicaid Dental Electronic Remittance Advice (ERA) Enrollment Registration?
Dental providers who want to receive electronic remittance advices from New Hampshire Medicaid are required to file this enrollment registration.
How to fill out New Hampshire Medicaid Dental Electronic Remittance Advice (ERA) Enrollment Registration?
To fill out the enrollment registration, providers must complete the form with necessary information such as provider identification, contact details, and their preferred electronic payment method, ensuring all sections are accurately filled.
What is the purpose of New Hampshire Medicaid Dental Electronic Remittance Advice (ERA) Enrollment Registration?
The purpose of the enrollment registration is to facilitate the electronic transmission of remittance advices, allowing providers to efficiently manage their claims and receive payments in a timely manner.
What information must be reported on New Hampshire Medicaid Dental Electronic Remittance Advice (ERA) Enrollment Registration?
The registration must report information including the provider's Medicaid number, tax identification number, contact information, and preferred method for receiving electronic remittance advices.
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