Credentialing in New Mexico

New Mexico Medicaid provider enrollment is overseen by the Health Care Authority's Medical Assistance Division (MAD), which 'oversees Medicaid provider enrollment, re-enrollment, and re-validation' through the Provider & PED Enrollment System.

NM Health Care Authority, Providers · checked Jul 2026

Turquoise Care replaced Centennial Care as New Mexico's Medicaid managed-care program on July 1, 2024. Four MCOs: Blue Cross Blue Shield of New Mexico (BCBSNM) and Presbyterian Health Plan continue from Centennial Care, while Molina Health Care of New Mexico and United Health Care are new; Western Sky Community Care (Centene) exited and its members were reassigned. Children in state custody are enrolled in Presbyterian Health Plan regardless of family plan choice.

NM Health Care Authority, Turquoise Care Overview FAQ · checked Jul 2026

A statewide Medicaid provider revalidation wave began in June 2026 ('Medicaid Provider Revalidation Begins in June' per the HCA providers page), on top of the standard 5-year federal revalidation floor. Stale enrollments risk deactivation in the wave.

NM Health Care Authority, Providers · checked Jul 2026

45 calendar days. Within 45 calendar days of receiving a credentialing request, a health carrier must assess and verify the provider's qualifications and determine whether to approve or deny the application (13.10.28.11(C) NMAC, effective 01/01/2017 and never amended). The carrier must acknowledge receipt by certified mail within 10 days and send deficiency requests within 10 business days.

13.10.28 NMAC, Provider Payment and Provider Credentialing Requirements (OSI) · checked Jul 2026

New Mexico has a real payment lever: 13.10.28.12 NMAC ('Reimbursement by Health Carrier Upon Delay in Credentialing Process') requires a health carrier to reimburse a provider's clean claims for covered services when the date of service is more than 45 calendar days after the credentialing request and the carrier has approved, or has failed to approve or deny, the application (clean license and malpractice coverage conditions apply). Services rendered after day 45 are payable even while the decision is pending.

13.10.28 NMAC, Provider Payment and Provider Credentialing Requirements (OSI) · checked Jul 2026

Billing for supervised non-independent BH practitioners is agency-only: only the 15 agency types listed in 8.321.2.9(D) NMAC (CMHCs, FQHCs, IHS/tribal facilities, hospitals, core service agencies, behavioral health agencies, school-based health centers, and others) may bill their services. Group practices are NOT on the list, so solo/group practices cannot bill associate work. The rendering practitioner must themselves be enrolled as a MAD provider (8.321.2.9(E)(4)) and renders under their own NPI once enrolled. Non-independently licensed rendering tiers under 8.321.2.9(E)(2) include LMSW, LMHC, LPC, LAMFT, psychologist associate, and LSAA.

8.321.2 NMAC, Specialized Behavioral Health Services · checked Jul 2026

Counselors, MFTs, art therapists, and alcohol/drug-abuse counselors are licensed by the Counseling and Therapy Practice Board, administratively attached to the NM Regulation and Licensing Department (RLD). Social workers are licensed by the NM Board of Social Work Examiners.

NM RLD, Counseling and Therapy Practice Board · checked Jul 2026

New Mexico is NOT a Counseling Compact member. It is absent from the counselingcompact.gov compact-jurisdictions list (verified 2026-07-04). There is no compact-privilege lane into New Mexico; out-of-state counselors must license by endorsement.

Counseling Compact, Compact Jurisdictions list · checked Jul 2026

Behavioral health is integrated in the Turquoise Care MCOs, no statewide BH carve-out or BHO. The Medicaid BH Policy and Billing Manual (issued by MAD, HCA's Behavioral Health Services Division, and CYFD Behavioral Health Services) requires MCOs to provide MH/SUD services in all benefit classifications (inpatient, outpatient, emergency care, prescription drugs) per the Medicaid Managed Care Services Agreement.

NM HCA, Medicaid Behavioral Health Services 2025 Policy and Billing Manual (Introduction) · checked Jul 2026

Master's-level behavioral health interns enroll in NM Medicaid with Provider Type 445 and Specialty 254 (psychology interns: specialty 255), registering an NPI with taxonomy 390200000X. While an employee's or intern's Medicaid enrollment is pending, the supervisor's name and NPI go in the rendering field with a U7 modifier (the enrollment application must already be submitted); once enrollment completes, the agency must stop using U7 and list the employee, including an intern, as the rendering provider.

NM HCA, Medicaid Behavioral Health Services 2025 Policy and Billing Manual (Introduction) · checked Jul 2026

The New Mexico Health Care Authority (HCA) is a new agency that launched on July 1, 2024, created by merging the New Mexico Human Services Department with divisions from General Services, the Department of Health, and the Office of Superintendent of Insurance. Older Medicaid documents and letters still carry the HSD name.

NM Health Care Authority, About the Department · checked Jul 2026