New Mexico Medicaid Announces Claims Process Update
New Mexico Health Care Authority (HCA) and its Medical Assistance Division (MAD) have stated an upcoming update to the state Medicaid claims processing system. In the late spring, the state will release Turquoise Claims as a new claims management platform that will operate through the YES.NM.gov. The state has already informed contracted providers of the transition plans, and they will be notified even further before the actual date of launch.
New Payer ID Code
As part of the transition to Turquoise Claims, the payer ID code for UnitedHealthcare Community Plan of New Mexico will change on the day the new system goes live. To prevent claim denials and delays in processing, the providers are encouraged to follow the following steps:
Providers should contact the clearinghouse to add payer ID 87748 to their list of electronic data interchange (EDI) transactions.
When submitting claims, enter the following payer ID:
- Between now and the system launch date, continue to use payer ID 87226
- On the day of the launch, use payer ID 87748
The claims submitted with the wrong payer ID in the targeted timelines will be rejected, and providers are required to be correct and resubmit the claim.
UnitedHealthcare has also reported that it will issue a reminder when the state verifies the actual start date.
No Other Changes to Submission Process
No changes are made to the process of claims submission except that the code of the payer ID is updated. The providers are expected to make claims using the methods currently in place, such as:
- Electronic Data Interchange (EDI)
- Application Programming Interface (API)
- The UnitedHealthcare Provider Portal
- Mail submissions
All questions related to EDI are to be addressed to the clearinghouses directly.
For Additional Assistance
- In the UnitedHealthcare Provider Portal, providers can access the portal through 24/7 chat.
- The queries related to the Turquoise Claims system can be sent to HCA-TurquoiseClaims@hca.nm.gov.
- Recurring updates, communications done previously, and common questions will be accessible through Turquoise Claims resources.
- Go to Turquoise Claims for information updates, past communications, and frequently asked questions.
