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Insurance Company.  \n[AmbetterHealth.com/en/nh](AmbetterHealth.com/en/nh 6559054_NH6PMKTMANE)[ 6559054_NH6PMKTMANE](AmbetterHealth.com/en/nh 6559054_NH6PMKTMANE)  \nInternal Approved 06262026  \nTABLE OF CONTENTS  \nAMBETTER HEALTH PROVIDER MANUAL REVISIONS-------------------------------7  \nWELCOME TO AMBETTER HEALTH----------------------------------------------------9  \nHow To Use This Provider Manual-------------------------------- -------------------------------- ----------------------------9  \nDental and Vision Provider Manuals-------------------------------- -------------------------------- ----------------------- 10  \nKey Contacts & Important Phone Numbers-------------------------------- -------------------------------- --------------- 10  \nNONDISCRIMINATION AND SECTION 1557 COMPLIANCE----------------------12  \nPRODUCTS & NETWORK DESCRIPTIONS-------------------------------- ----------13  \nAmbetter Health Solutions & ICHRA Overview-------------------------------- -------------------------------- ----------- 15  \nSECURE PROVIDER PORTAL-------------------------------- -------------------------16  \nFunctionality-------------------------------- -------------------------------- -------------------------------- ------------------ 16  \nAvaility Essentials-------------------------------- -------------------------------- -------------------------------- ------------ 17  \nDisclaimer-------------------------------- -------------------------------- -------------------------------- --------------------- 17  \nCREDENTIALING & RECREDENTIALING-------------------------------- ------------18  \nEligible Providers-------------------------------- -------------------------------- -------------------------------- ------------- 19  \nNon Registered CAQH Providers-------------------------------- -------------------------------- --------------------------- 19  \nCredentialing Committee-------------------------------- -------------------------------- -------------------------------- ---20  \nRecredentialing-------------------------------- -------------------------------- -------------------------------- ---------------20  \nPractitioner Right to Review and Correct Information-------------------------------- -------------------------------- ---20  \nPractitioner Right to Appeal or Reconsideration of Adverse Credentialing Decisions-------------------------------21  \nPROVIDER ADMINISTRATION-------------------------------- ------------------------22  \nProvider Types That May Serve As PCPs-------------------------------- -------------------------------- -------------------22  \nMember Panel Capacity-------------------------------- -------------------------------- -------------------------------- -----22  \nMember Selection or Assignment of PCP-------------------------------- -------------------------------- -----------------23  \nWithdrawing from Caring for a Member -------------------------------- -------------------------------- -------------------23  \nPCP Coordination of Care to Specialists-------------------------------- -------------------------------- ------------------24  \nSpecialist Provider Responsibilities-------------------------------- -------------------------------- ------------------------24  \nMEMBER RIGHTS & RESPONSIBILITIES-------------------------------- -------------------------------- -------------------24  \nPROVIDER RIGHTS & RESPONSIBILITIES-------------------------------- -------------------------------- -----------------28  \n[AmbetterHealth.com/en/nh](AmbetterHealth.com/en/nh) 1  \nProvider Rights-------------------------------- -------------------------------- -------------------------------- ----------------28  \nAPPOINTMENT AVAILABILITY & WAIT TIMES-------------------------------- -------31  \nWait Time Standards for All Provi","cbCaio4kBcxGhzOn","https://ap.wps.com/l/cbCaio4kBcxGhzOn","pdf",3133137,250,"English","# AMBETTER HEALTH PROVIDER MANUAL REVISIONS\n# WELCOME TO AMBETTER HEALTH\n## How To Use This Provider Manual\n## Dental and Vision Provider Manuals\n## Key Contacts & Important Phone Numbers\n# NONDISCRIMINATION AND SECTION 1557 COMPLIANCE\n# PRODUCTS & NETWORK DESCRIPTIONS\n## Ambetter Health Solutions & ICHRA Overview\n# SECURE PROVIDER PORTAL\n## Functionality\n## Availity Essentials\n# CREDENTIALING & RECREDENTIALING\n## Eligible Providers\n## Recredentialing\n# PROVIDER ADMINISTRATION\n## Provider Types That May Serve As PCPs\n## Member Panel Capacity\n# MEMBER RIGHTS & RESPONSIBILITIES\n# PROVIDER RIGHTS & RESPONSIBILITIES\n## Provider Rights\n# APPOINTMENT AVAILABILITY & WAIT TIMES\n## Wait Time Standards for All Provider Types\n## Travel Distance and Access Standards\n# COVERING PROVIDERS\n## Provider Phone Call Protocol\n# AMBETTER HEALTH BENEFITS\n## Overview\n## Integrated Deductible Products\n# COVERED SERVICES","[{\"question\":\"What is Ambetter from NH Healthy Families and who issues the Qualified Health Plan?\",\"answer\":\"Ambetter from NH Healthy Families is a Qualified Health Plan in the New Hampshire Health Insurance Marketplace underwritten by Celtic Insurance Company.\"},{\"question\":\"What does the manual cover regarding credentialing and recredentialing?\",\"answer\":\"It includes eligible provider requirements, non-registered CAQH provider handling, and processes for credentialing committee review, recredentialing, and provider rights to review and appeal adverse decisions.\"},{\"question\":\"What benefit areas are included in the 2026 manual?\",\"answer\":\"It provides benefit overviews such as integrated and non-integrated deductible products, maximum out-of-pocket expenses, covered services, and scenarios for when claims are considered for payment.\"}]","Provider and Billing Manual - 2026 | PDF",1789787526,88]