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New Mexico Medicaid Enrollment and Claims Denial

November 30, 2016

Blue Cross and Blue Shield of New Mexico (BCBSNM) has previously communicated the requirement for all providers (both billing and rendering) who are contracted with BCBSNM for Blue Cross Community Centennial to enroll in the New Mexico Medicaid program. The requirement assures that billing providers and rendering providers can always be identified on claims and encounter reports by having their NPI numbers registered in the Medicaid provider file, which is maintained by the New Mexico Human Services Department's (HSD's) fiscal agent (Xerox) through its Omnicaid system. This requirement also assures BCBSNM's encounter submission data will be accepted by the Medical Assistance Division (MAD).

Effective Jan. 1, 2017, all claims will be denied if a provider is not enrolled in the Medicaid program with an NPI that is associated with an active fee-for-service or managed care provider record in the Omnicaid system. Every NPI/Taxonomy combination must be registered before submitting claims.

If you have not previously enrolled, do so immediately. If you have previously enrolled, verify that the taxonomy code used during the enrollment process is correct.

New Mexico Medicaid Portal

Visit the New Mexico Medicaid Portal to enroll online or check enrollment status.

Gather the following required information to streamline the enrollment process:

Required

If Applicable

  • Federal Tax Number/FEIN
    (IRS Letter CP-575 or 147-C)
  • New Mexico CRS Tax ID Number
  • Fully executed Form W-9
  • NPI and Primary Taxonomy
  • Physical Address, Phone & Fax Numbers, and Email Addresses
  • Mailing Address, Email Address
  • Billing Addresses, Phone & Fax Numbers, and Email Addresses
  • Business License Information
  • Professional License Information
  • Current malpractice, medical liability, or professional liability insurance
  • Proof of 501(c)(3) status
  • Individual Provider's Social Security Number and Date of Birth
  • DEA Number
  • CLIA Number
  • IHS Certified or Tribal 638 Contract Program (Certificate or Contract)
  • Title XVIII Medicare Certification Letter
  • JCAHO Certification Letter

Attaching Files:

  • Files are limited to a maximum file size of 5 MB.
  • Accepted file types include PDF, JPG, TIF, PNG, and Microsoft Word (.doc or .docx).
  • File types not accepted are compressed ZIP files, Microsoft PowerPoint or Excel, or any password-protected files.

Claims Submission

It is important when submitting claims that they contain complete and correct information. The examples below show the areas related to provider enrollment in Medicaid that must be completed in order for claims to be accepted.

Please note, when billing with multiple NPI/Taxonomy combinations, each combination must be registered with HSD. If a claim contains a combination not registered with HSD, the claim will be denied.

The rendering provider's NPI and taxonomy must be entered.

Additional information about the mandatory enrollment requirement can be found by viewing HSD's Medical Assistance Program Manual Supplement 15-03, dated May 13, 2015 .

If you have any questions, please contact BCBSNM's Network Services Department at (800) 567-8540 for assistance.