Updated CAQH & Provider Specialty Profile Enrollment Forms

Date: 11/23/20

We are pleased to announce updates to our CAQH and Provider Specialty Profile (PSP) Enrollment forms.

The changes include incorporating an indicator for Telehealth as well as allowing for multiple servicing and covering locations to be included on one form.

The new fillable forms are live on the NH Healthy Families and Ambetter from NH Healthy Families Provider Resource pages and can be found at the following locations:

NH Healthy Families (under Forms)

Ambetter from NH Health Families

If you have any questions, please contact NH Healthy Families at 1-866-769-3085.

Sincerely, NH Healthy Families