How to Enroll Online as a Non-Billing Rendering Provider

You can complete the NH MMIS Health Enterprise Portal online pages to enroll as a non-billing rendering provider.

Optionally, you can:

• Delete information. To delete information from a record, in the table, click the appropriate row and on the panel's action bar, click Delete.
• Save the application. To complete the application at a later time, click Save.
• Exit the application. To exit the application without saving your changes, click Exit Application.
• Reset your entries. To clear the fields and remain on the page or panel, click Reset.
• Cancel your entries. To close the page or panel without saving your changes, click Cancel.

To enroll as an individual non-billing rendering provider

1. Do one of the following:
   • On the Provider menu, click Enrollment.
   • On the Quick Links pod on the public Home page, click Enrollment.

The Provider Enrollment page is displayed.

2. In the Become a Non-Billing Rendering Provider panel, click Individual Non-Billing Rendering Provider Enrollment.

   The Non-Billing Rendering Provider Enrollment Instructions page is displayed.

3. Read the instructions, and click Continue.

   The first of several online enrollment pages is displayed.

4. To page through and complete the following enrollment pages, click Continue:
• Identifying Information
• Licensure / Certification
• Provider Identifier Number
• Service
• Group Affiliation
• Exclusion/Sanction

Tip: To complete or submit an application at a later time, click Save.

Warning: All entered information is lost if you choose to exit the application before saving.

5. To check your application for errors, click Validate Application and resolve any issues.

   The Submit Application Step 2 page is displayed if there are no errors.

6. Optionally, to go back and edit the application before you submit it, on the Submit Application Step 2, do the following:

   1. Click Edit Application.
   2. Starting from Step 4, edit the application as needed.

7. To submit the application, on the Submit Application Step 2 page, click Confirm Submit.

   Tip: All required fields must be entered for all locations associated to this application before the submission can occur. After you submit your application, you cannot recall it to change or add information at a later date. Your enrollment application information is submitted to New Hampshire for approval.

   The Submit Complete page is displayed.

8. If you submitted the application, on the Submit Complete page, you must also do the following:
   • Record your application tracking number, including the trading partner application number, if applicable.
   • Print the required documents, such as Provider Enrollment Signature, Medicaid Provider Participation Agreement, and Document Requirement Checklist.
   • Sign the required documents.
   • Send in all signed and required additional documents to the address provided.
   • To print a copy of the enrollment application you just completed, click Print Application.
   • To exit the application form, click Exit Application.

What's Next?

Individual providers can optionally enroll as a non-billing ORP provider.

See Also