Turquoise Claims Frequently Asked Questions

Information for Providers 

Turquoise Claims is the new Medicaid claims management system for New Mexico that will eventually replace the current Medicaid claims management system (Omnicaid) and the New Mexico Medicaid Provider Web Portal. 

  • General Information
    Q: Where will I access Turquoise Claims?
    A: You can access Turquoise Claims, the Provider/Presumptive Eligibility Determiners Enrollment system and the Learning Management System on YES.NM.GOV. This portal will serve as a one-stop location for all your provider tools.
    Q: Why is a new claims management system needed?
    A: Turquoise Claims is part of a broader effort to update all pieces of the New Mexico Medicaid system. It will improve efficiency, accuracy in billing and payments, and ensure compliance with federal regulations.
    Q: What new features will Turquoise Claims offer?
    A: Key new features include:
    • Custom billing templates for routine services managed by your organization
    • A user-friendly portal with configurable user security levels
    • Real-time claim status and member eligibility inquiries
    Q: When will the new system go live?
    A: New Mexico Health Care Authority is making final improvements and conducting user testing. The launch date has not been determined, but HCA and the managed care organizations will continue to provide updates as more information is available.

  • Training
    Q: Will training be available for providers?
    A: Yes. HCA will offer two flexible training options:
    • Self-Paced Training − Complete online modules at your own pace, covering all major functions of the new system
    • Instructor-Led Virtual Training − Participate in live, instructor-led sessions featuring real-time walkthroughs with Q&A
    Q: What topics will the training cover?
    A: The trainings will include:
    • How to log in and navigate the new system
    • Step-by-step instructions for submitting claims
    • How to use workflow tools and features efficiently
    • Troubleshooting tips and where to get help
    Q: Is training required?
    A: While not mandatory, it is recommended that all providers and staff complete training to ensure a smooth transition to the new system.

  • Claims Submission
    Q: Will the way I submit claims directly to the State change (Fee-For-Service)?
    A: In some cases, yes.
    • Portal Submissions − The process will be similar, but instead of submitting claims through the Medicaid Provider Web Portal, you’ll submit them in the new Turquoise Claims system at YES.NM.GOV.
    • Electronic Data Interchange − If you submit a file through a clearinghouse, nothing will change.
    Q: Are paper claims submissions changing?
    A: The process won’t change, but FFS claims must be sent to a new PO Box and cannot be dropped off. HCA will provide details closer to launch and as part of your training. 
    Q: Can multiple claims be submitted through the Turquoise Claims portal at the same time?
    A: No, only single claims can be submitted through the portal. However, the following features will make it easier for you:
    • You can generate a new claim using details from a previously processed claim. This saves time by reusing existing data while allowing necessary updates.
    • You can submit a claim using a pre-built template tailored for recurring or standardized claims. Templates streamline the process by pre-filling commonly used information.

  • Claims Submission to Blue Cross and Blue Shield of New Mexico
    Q: Are BCBSNM portal submissions changing?
    A: There are no process changes to claims submitted directly through BCBSNM’s portal. Any other changes will be communicated directly from BCBSNM.
    Q: Are paper claims submissions changing?
    A: No, the paper claim submission process for BCBSNM will remain the same.
    Q: Are there new requirements for EDI submissions to BCBSNM?
    A: No, there are no new requirements for BCBSNM.
    Q: What is staying the same for EDI submissions to BCBSNM?
    A:
    • Clearinghouse submission process remains unchanged.
    • You’ll continue receiving status notifications via your clearinghouse.
    • BCBSNM will adjudicate claims as we currently do.
    Q: For claims to BCBSNM, what happens once BCBSNM confirms receipt of my EDI file?
    A: Once BCBSNM confirms receipt, you should resume working directly with BCBSNM for any claim-related issues, just like you do today.

  • Transition

    Q: Will there be any disruption to payments?
    A: No, there will be no interruption in claims payments. 

  • Communication

    Q: Where can I go for more information or questions?
    A: Watch your email inbox, or go to the Turquoise Claims page on the HCA website to see all prior emails to providers. For questions, email HCA-TurquoiseClaims@hca.nm.gov.