New Hampshire has specific guidelines and laws regarding medical billing, particularly for healthcare providers and facilities. Here are the key points:New Hampshire Balance Billing Law

• Prohibition on Balance Billing: New Hampshire law prohibits anesthesiologists, radiologists, pathologists, and emergency medicine providers from billing commercially insured patients who are treated at an in-network hospital or ambulatory surgery center for more than the in-network cost-sharing amount.

New Hampshire Healthy Families Billing Manual

• Claims Filing Instructions: New Hampshire Healthy Families, a managed care organization, requires providers to adhere to specific billing requirements to ensure timely processing of claims and avoid unnecessary rejections or denials.
• Required Information: Providers must include the following information on claims:
  • Patient name and ID number
  • Date of service
  • Total charges
  • Provider name
  • Present on Admission (POA) indicator for inpatient facilities
  • Medicaid ID numbers for out-of-network providers
  • Medicare coverage or other third-party coverage information
  • Required Consent Forms
• Claim Submission: Claims must be submitted within 180 days of the date of service for original claims. Corrected claims must be submitted within 365 days of the date of service.
• Reconsideration and Claim Disputes: Requests for reconsideration and claim disputes must be received within 180 days from the original date of notification. Claims received outside of this timeframe will be denied for untimely submission.
• Electronic Data Interchange (EDI): New Hampshire Healthy Families supports electronic claim submission, which reduces administrative costs and improves transaction times.

New Hampshire Insurance Department (NHID) and Federal No Surprises Act (NSA)

• NSA Provisions: The NSA expands the prohibition against balance billing to all emergency care, out-of-network providers at in-network facilities, and air ambulatory providers. This provides greater protections against balance billing than New Hampshire's current law.
• Enforcement: The NHID will enforce the NSA provisions for emergency and pathology, radiology, and anesthesiology services in non-emergency cases. In all other cases, the federal Centers for Medicare & Medicaid Services (CMS) will enforce the NSA provisions.

Additional Guidelines

• Verification Procedures: New Hampshire Healthy Families verifies claims by checking for completeness and accuracy of required fields on the claim form, including the POA indicator for inpatient facilities.
• Provider Communication: Providers can contact New Hampshire Healthy Families for claim status, payment amounts, or denial reasons. They can also submit corrected claims or request reconsideration.

These guidelines and laws aim to ensure that healthcare providers and facilities follow specific procedures for billing and claims submission, protecting patients from surprise medical bills and ensuring timely and accurate payment for services.