New Mexico to Enforce Mandatory Taxonomy and ZIP Code Accuracy on Claims

New Mexico Healthcare Authority (HCA) will commence imposing additional claim submission requirements on providers in March. Providers will have to provide the correct taxonomy and ZIP codes on all claims made under the Turquoise Care managed care organizations.

Under the new policy, claims made without a taxonomy code and claims made with an incorrect taxonomy and /or ZIP code will be rejected. Its implementation is in line with the current fee-for-service billing practice of HCA and applies to all providers under the Turquoise Care program in the state.

Updated Code

Turquoise Care has updated its taxonomy crosswalk to accommodate new changes made by the National Uniform Claim Committee (NUCC). Check with the New Mexico Medicaid Portal to ensure that the appropriate taxonomy code is linked with provider enrollment and to confirm that their claims are submitted correctly.

Critical Compliance Requirements

The following requirements should be met by healthcare providers when filing institutional and professional claims:

• Mandatory Taxonomy Code: Every claim should consist of the relevant taxonomy code of billing used in relation to the service provided.
• Accurate Taxonomy Code: The 10-digit taxonomy code should reflect the registration of the provider in terms of classification and specialization, as it is registered at HCA.
• Correct ZIP Code: Claims should contain the ZIP code of the physical place of providing the services. The information is utilized in order to identify specialty coverage and network adequacy in particular geographic locations.

If you have questions, you can connect to chat 24/7 in the UnitedHealthcare Provider Portal.