July 26, 2018
Focus On…
- Notice to Durable Medical Equipment (DME) Providers Regarding RuralZip Codes – New
- Coming Soon: Provider Enrollment Updates Via the Web Portal – New
- FFS LTC Nursing Facilities Rates Update – New
- FFS Hospice Rates Update
- New Mexico Medicaid Web Portal: Password Reset
- Third Party Liability (TPL)
- Claims Secondary to a Primary Payer: Timely Filing Denials
- Medicaid Fee for Service – Mammogram codes
- Medicaid Fee for Service – CLIA Waived Tests
- Provider Enrollment Helpful Tips
- ITU Service Providers
Monthly IHS Open Forum
Conduent IHS Training Webinar – Navajo Nation
- New Mexico Medicaid Provider Resource List
- Conduent Contact Information
Notice to Durable Medical Equipment (DME) Providers Regarding Rural Zip Codes – New
The Medical Assistance Division (MAD) working with Conduent; updated the durable medical equipment (DME) rates in order to match Medicare payment for DME in rural zip codes. A “DME Rural Location Fee Schedule”, including the list of zip codes that are considered rural or non-contiguous, is posted on the HSD website. Go to scroll to the bottom of the page, click the “I agree” button, and then click on the submit button. Locate the DME Rural Location Fee Schedule alphabetically on the page.
Follow the instructions on the fee schedule. Providers will need to bill a U1 modifier to receive the rural rate when supplying an item to a rural address as determined by the zip code. A detailed Supplement regarding the DME rural rates is forthcoming.
Note that the non-rural rates for DME can be found on the same page under “HCPCS Codes”.
The Medical Assistance Division will work with Conduent to reprocess claims at the higher rate which may have been paid at the lower rate. This includes when the billing provider is in a rural zip code and the recipient is in a rural zip code; the item is on the DME Rural Location Fee Schedule; the date of service is between June 1 and July 20, 2018 and the payment date is prior to July 30, 2018.
If you have any questions related to this article, please contact the Provider Relations department for assistance at 1-800-299-7304, option 6.
Coming Soon: Provider Enrollment Updates Via the Web Portal – New
Conduent is taking steps to implement a more timely and efficient process for submitting provider enrollment updates. The new and improved Provider Update tool will be available starting August 2018. Providers with access to the New Mexico Medicaid Web Portal will be able to send updates electronically. This new process will replace the need to mail or fax the MAD 304 form.
The submission through the web portal is secure and allows for a quicker update of pertinent information to the provider record such as license, address, or affiliations.
If you have any questions related to this article, please contact the Provider Relations department for assistance at 1-800-299-7304, option 6.
FFS LTC Nursing Facilities Rates Update – New
Effective July 1, 2018, rates were updated for Type 211, 212 and 213 providers, also identified as LTC Nursing Facilities (NF).
The current NF-LNF/HNF fee schedule can be found here:
If you have any questions related to this blast, please contact the Provider Relations department for assistance at 1-800-299-7304, option 6.
FFS Hospice Rates Update
Effective October 1, 2017, rates were updated for Type 362 providers, also identified as Hospice. The revenue codes affected by the update include 0551, 0651, 0652, 0655, and 0656.
The current Hospice fee schedule can be found here:
If you have any questions related to this article, please contact the Provider Relations department for assistance at 1-800-299-7304, option 6.
New Mexico Medicaid Web Portal: Password Reset
Do you need your New Mexico Medicaid Web Portal password reset?
By clicking the “I forgot my password” option on the Provider Login page, users will be asked to confirmtheUser ID (case sensitive) prior to answering the security question thereafter. Once the security question has been answered, a temporary password will be sent to the users’ email address on file.
Additionally, users may contact the Master Administrator of the web portal account to have the password reset.
If you have any further question regarding resetting your password, please contact the HIPAA Helpdesk at 1-800-299-7304 option 6 and then option 4.
Third Party Liability (TPL)
In some cases, Medicaid is the payer of last resort.Third party payers, such as group healthinsurance, auto liability insurance, worker’s compensation, court-ordered health coverage, Medicare, etc., will pay first to the limit of their legal liability and then Medicaid will consider the claim for payment.
If you would like to report and/or update the TPL information on file with New Mexico Medicaid, please use the following contact information listed directly below:
For Clients: Call 1-888-997-2583
For Providers: Call 1-800-299-7304, option 6or email .
If you have any questions related to this notice, please contact the Provider Relations department for assistance at 1-800-299-7304, option 6.
Claims Secondary to a Primary Payer: Timely Filing Denials
When the provider can document that a claim was filed with another primary payer including Medicare, a HSD contracted MCO (when Medicaid fee for service should have been billed instead), Medicare replacement plans, or another insurer, the claim must be received by Conduent within 90 calendar days of the date the other payer paid or denied the claim as reported on the explanation of benefits or remittance advice of the other payer, not to exceed 210 calendar days from the date of service. It is the provider’s responsibility to submit the claim to another primary payer within a sufficient timeframe to reasonably allow the primary payer to complete the processing of the claim and also meet the MAD timely filing limit.
If you have claims that were submitted within the 90 day limit from the primary insurance’s payment date but denied for timely filing due to the 210 day final filing limit policy AND you have proof the claims were submitted to the primary insurance within 90 days of the date of service AND either a delay in processing the claim or appeals and reconsideration requests caused the claim to exceed the 210 day final filing limit the claims can be resubmitted with a reconsideration request. For each claim submit an original red claim form and attach a reconsideration request with explanation of the circumstance that caused the delay and proof that the claim was submitted to the primary insurance within the above timeframe. (Note that the claim still must have been received and processed by Conduent within two years of the date of service, regardless of the payment issue with the primary payer.)The Medical Assistance Division (MAD) has advised that claims that exceed the 210 day final filing limit will otherwise not be considered for payment.
Reconsideration Request Form:
The information for Timely Filing is found on page 4 under the 8.302.2.11 portion section A. (3):
The rule can also be accessed via:
Medicaid Fee for Service – Mammogram codes
Attention: Hospitals, Physicians, Laboratory and Radiology Providers
Effective January, 1, 2018, New Mexico Medicaid Fee for Service replaced HCPCS codes G0202, G0204, and G0206 with CPT codes:
77067: SCR MAMMO BI INCL CAD
77066: DX MAMMO INCL CAD BI
77065: DX MAMMO INCL CAD UNI
If you have any questions related to this email blast, please contact the Provider Relations department for assistance at 1-800-299-7304, option 6.
Medicaid Fee for Service – CLIA Waived Tests
Attention: Hospitals, Physicians, Laboratory and Radiology Providers
New Mexico Medicaid Fee for Service has updated the NM Medicaid claims system to reflect the following waived tests under CLIA (Clinical Laboratory Improvement Amendments):
If you have any questions related to this email blast, please contact the Provider Relations department for assistance at 1-800-299-7304, option 6.
Provider Enrollment Helpful Tips
The New Mexico Medicaid Provider Enrollment team is taking steps to implement a more timely and efficient process so you may participate as a provider with New Mexico Medicaid. Conduent is working towards reducing the number of Provider Applications that are returned for missing or incorrect information.
To minimize the possibility of your application being returned, we recommend submitting an application through the NM Medicaid Web Portal ( On the web portal, you will be able to reference the Provider Type and Specialty List while completing the application. An error message will alert you when required fields are not populated.
Below are some helpful tips to assist you in completing your provider enrollment application.
1.)Provider already active?
Tip: Before you fill out an application, contact our call center(800) 299 - 7304 option 6 or (505) 246 - 0710 option 6. Or check the NM Medicaid web portal to see if your provider is already an active NM Medicaid provider (the provider search feature is under public information in the provider section). If the provider is active, you will need to update your information by completing a MAD 304 form to affiliate them to your group. You are not required to complete an application.
2.) Address not USPS Verifiable
Tip: The state requires your mailing address to be USPS verified to ensure correspondence is received. You can verify your address is USPS verifiable by going to: to confirm the address before you submit your application.
3.)Submitting Proof of Insurance or Certificate of Insurance (COI)
Tip: To avoid processing delays, note that we cannot accept anyproof of insurance or COI that will expire within 30 calendar days from the day Conduent receives your application. When submitting proof of insurance or COI, verify that the coverage dates listed cover your requested start dates. If you are requesting a retroactive effective date, make sure that date is included as well. If the proof of insurance or COI has covered provider names included, ensure the provider on the application is listed. It is not necessary for the applicant’s name to be on the proof of insurance or COI, if the associated group is the only name on the document.
4.)Board Certification Effective and End Dates
Tip: When Board Certification is required, be sure to send a certification which includes an effective and end date. Providers have access to their individual accounts on board websites; however, Conduent only has public view access and cannot obtain the start and end dates.
ITU Service Providers
- Monthly IHS Open Forum
- Second Wednesday of every month; 2:00pm-3:00pm (MST)
- Location: WebEx
- Conduent IHS Training Webinar – Navajo Nation
- August 14th, 2018 at 10:00 AM MT
- Contact William Landgraf for registration details
For more information or questions about IHS matters, please contact the Conduent IHS Provider Field Representative,r by phone at 505-767-8712.
New Mexico Medicaid Provider Resource List
New Mexico Medicaid Portal –
Claim Inquiries, Eligibility Verification, Electronic Claim Submission, Provider Manuals, E-News
NM Human Services Department –
Supplements, Memos, Provider Billing Packets and Policy
Conduent Provider Relations Call Center – (800) 299 - 7304 option 6 or (505) 246 - 0710 option 6.
Claim Status, Eligibility, Prior Authorization, Medicaid Updates
Conduent Provider Relations Helpdesk –
Claim research assistance and general Medicaid inquiries
Conduent HIPAA Helpdesk –
Assistance on NM Web Portal, EDI inquiries, and Online Claim Submission with DDE (Direct Data Entry)
Conduent Provider Enrollment Helpdesk -
Provider Enrollment Applications, Forms & Instructions
NM Medicaid Recipient Helpdesk – (888) 997 – 2583 or (505) 247 – 1042
Eligibility inquiries, Fee-for-Service Replacement Medicaid Identification Card, Enroll or change a Managed Care Organization and Eligibility application status
Medical Assistance Division, Program Rules –
NMAC for Programs administered by the Medical Assistance Division
Conduent Contact Information
Disclosure- The objective of the E News, training, and webinars is to inform and educate. Articles reflect information at current time and may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations, and other interpretive materials for a full and accurate statement of their content. E News is published monthly and available on the NM Medicaid Web Portal.