New Mexico Medicaid Portal

New Mexico Medicaid E-News
January 20, 2016
Focus On…
Proper use of Taxonomy Codes (NEW)
ICD-10 Denial Codes Updated (NEW)
Update to HIPAA transaction 271 Response (NEW)
Provider Enrollment Updates and Applications
Web Portal - Update to Provider Eligibility Search Results
PERM (Payment Error Rate Measurement Program) Information
Supplements to Program Rules
DME Billing
2012 ADA Paper Claim Forms
Emergency Medical Services for Aliens (EMSA) Claim (COE 85)
Resubmitting Claims and Submitting Adjustments
Reconsideration Requests for Non-Duplicate Services
ITU Service Providers
Albuquerque Area (RAM)
Navajo Area Providers (BOM)
IHS Monthly Call-in Session: Wednesday, February 10, 2016
Staying Informed & Trained on NM Medicaid Fee for Service
Training-Webinar: Tuesday, January 26 2016
Top Ten Mediciad Denials
Xerox Contact Information
Proper use of Taxonomy Codes
Taxonomy codes are used in conjunction with NPI numbers to determine the Medicaid provider ID
number for provider that will receive payment. If you are a billing provider with more than one active NM
Medicaid Provider IDs sharing the same NPI, PLEASE note that a corresponding taxonomy code has to
be submitted on the claim. Including the correct taxonomy code will ensure a more accurate and timely
processing of claims. The list of taxonomy codes per provider type can be found on the following link
from the HSD website:
Taxonomy Codes on HSD Website
If a claim is submitted without the correct taxonomy code, denial code 0299 (Billing NPI Match Multiple
Medicaid IDs) will be seen on your Remittance Advice for the corresponding claim. If you receive denial
code 0299, your next step would be to resubmit the claim with the accurate taxonomy code using the link
provided above. Please visit the Training Presentation section of the NM Medicaid Web Portal
( regarding
perspective billing instruction types that fit your need to determine how and where taxonomy codes are
submitted on claims.
ICD-10 Denial Codes Updated
The following ICD-10 exception codes have been updated in the New Mexico Medicaid claims system.
0440, 0446, 0450, 0458, 0460, 0470, 0472, 0480, 0488, 0490, and 1900
The codes are now set to deny when an incorrect diagnosis code is used on the claim. If you receive this
denial code on a claim, please resubmit your claim with the correct ICD-10 diagnosis code(s).
Update to HIPAA transaction 271 response
Effective January 12th, HIPAA transaction 271 response will provide information for ALL Categories of
Eligibility (COE) for a requested recipient. Providers will have the ability to view all open and closed COE
with corresponding date spans.
Previously the HIPAA Transaction 271 response would minimially display the benefit COE for Date of
Service (DOS) queried.
For any additional questions, please contact the HIPAA Helpdesk at 1-800-299-7304, option 6.
Provider Enrollment Updates
If you are an active provider please do not submit an application to request an update, such as an
address change. Submitting an application for a routine update will result in a delay of processing.
Providers wanting to update information must submit a Provider Update Form (MAD 304) which requires
a signature and certificate of insurance.
Examples of when to utilize a provider update form:
Adding an NPI to your provider number
Adding specialties
Requesting a Cross Reference Update
Address changes
Provider Enrollment Applications
For applications pending more than 20 days, please contact the Provider Relations Helpdesk at 800-2997304 or by email at NMPROVIDERSUPPORT@XEROX.COM to determine if any additional information
is required.
Web Portal - Update to Provider Eligibility Search Results
The New Mexico Medicaid Web Portal provides information on ALL Categories of Eligibility (COE) for a
recipient in response to a Provider eligibility inquiry. Providers are now able to view all open and closed
eligibility categories for recipients with their corresponding eligibility date spans.
Previously our portal responses to Provider eligibility inquiries would minimally display the benefit COE for
each span within the Date of Service range inquired. This update allows providers and recipients see the
same eligibility results on the New Mexico Medicaid Web Portal.
PERM (Payment Error Rate Measurement Program) Information
What is PERM? What can be expected of me when a PERM request arrives?
Overview of the Payment Error Rate Measurement Program
The purpose of the Payment Error Rate Measurement (PERM) program is to produce a national-level
error rate for Medicaid and the Children’s Health Insurance Program (CHIP) in order to comply with the
requirements of the Improper Payments Elimination and Recovery Improvement Act (IPERIA) (2012).
Medical Record Request Process
The PERM Review Contractor, A+ Government Solutions is responsible for requesting all medical record
documentation associated with the randomly selected Medicaid Fee For Service (FFS) and CHIP FFS
claims. Providers have a 75-day window to submit the medical record documentation. At a minimum, A+
Government Solutions will send four letters and make four phone calls to each provider throughout the
75-day window, as needed, to follow up on documentation not yet received.
A+ Government Solutions first verifies the provider information by contacting either the performing
provider or the billing provider by phone, using contact information provided by the State. A+ Government
Solutions will provide information on the patient, date of service, and type of service and notify the
provider that a written request is forthcoming. A+ Government Solutions will verify the provider’s name,
phone number, and mailing address where medical records can be obtained and determine to whom the
letter should be addressed. A+ Government Solutions will also determine the preferred method for the
request (fax or first class mail). If A+ Government Solutions is unable to verify the provider information on
the State’s claim files after using other means (e.g., internet, directory assistance), A+ Government
Solutions will contact the State to obtain more current provider information.
A+ Government Solutions will fax the PERM initial request letter package, with cover letter to the fax
number provided within one hour of the telephone call or as reasonable during high volume times and
constraints. If mail delivery is preferred, A+ Government Solutions will send the initial request letter
package to the point of contact at the confirmed address via standard United States Postal Service
(USPS) first class delivery within one business day of the telephone contact.
The letter package includes a claim summary with details for the provider to identify the appropriate
record (e.g., the beneficiary name; date of service; diagnostic code (ICD-9-CM); service code (CPT,
HCPCS or prescription number); and total amount of claim or total amount for service). The letter
package also includes a PERM Fax Cover Sheet that describes the specific documentation being
requested (a request list is attached to the initial request letter) and asks that all medical documentation
pertaining to the specific service rendered be submitted to A+ Government Solutions. Each claim is
assigned a specific claim category and claim category specific components (i.e., history and physical,
plan of care etc.) of records are listed on the record documentation request list. Finally, the letter indicates
that the provider has 75 calendar days from the issue date of the letter to provide the requested medical
record to A+ Government Solutions. The last enclosure of the letter package includes instructions for
providers’ submission of medical records to A+ Government Solutions. Records may be submitted by the
USPS, a toll free fax number, CD, or electronic submission of Medical Documentation (esMD) to A+
Government Solutions. For more information about esMD, see
If the provider does not submit the requested information by the deadline, A+ Government Solutions
sends a final letter that contains the detailed request information. The letter also informs the provider that
failure to submit the requested medical record has resulted in a PERM error and that a notice of the error
will be submitted to State officials who may seek recoveries for claims in which medical records are not
received by A+ Government Solutions in a timely manner.
If providers have any questions please contact the State PERM liaison Julio Maestas at:, Phone number: 505-827-7308
Supplements to Program Rules
HSD posted Supplement 15-03 on May 13, 2015. This Supplement lists multiple topics, including ICD10, Billing Using Paper Claims, etc.
Xerox and HSD highly recommend you learn more about the addendums to MAD NMAC Program Rules
by clicking on the link below:
DME Billing
New Mexico Medicaid encourages providers to become familiar with the NMAC rule which outlines how
Durable Medicaid Equipment (DME), Medical Supplies and Nutritional products are reimbursed by
NMAC Program Rule: 8.324.5
Rental payments must be applied towards the purchase with the exception of ventilators. Unless
otherwise specified the provider’s billed charges must be the usual and customary charge for the item or
service. Reimbursement for rental of DME is made at the lesser of logic.
Medical Assistance Division follows Medicare regulations regarding capped rental. For rental months one
through three, the full fee schedule rental fee is allowed. For rental months four through 13, the rental fee
schedule rental fee is reduced by 25 percent. No additional rental payments are made following the 13th
month or to the most current schedule determined by Medicare. The provider may only bill for routine
maintenance and for repairs, and oxygen contents to the extent as allowed by Medicare.
If you have any questions please call the New Mexico Medicaid Call Center at 1-800-299-7304, option 6
or via email at
2012 ADA Paper Claim Forms
Xerox New Mexico Medicaid Fee for Service will no longer accept black and white ADA 2012 paper claim
form(s). Black and white paper or photo copied claim forms are not recognized by the Optical Character
Recognition (OCR) scanning system. Black and white paper or photo copied claim forms received by the
Fiscal Agent will not be processed and will be returned to the Provider.
Providers are encouraged to:
Submit claims electronically either with your EDI solution or through the NM Medicaid Portal.
Obtain and start using RED ADA 2012 paper claim form.
Providers are reminded it is your responsibility to submit claims correctly and within the Timely
Filing guidelines.
Emergency Medical Services for Aliens (EMSA) Claim (COE 85):
Recipient must obtain an approved MAD 310 from an ISD office and present the MAD 310 to the hospital
or physician who rendered services. Providers must submit the EMSA claim on paper with the approved
MAD 310 or Notice of Case Action and any other required documents such as ER notes, History and
Physical for admission, discharge summary (if admitted), Surgical reports and Facility Transfer notes (if
transported to another facility).
Resubmitting Claims and Submitting Adjustments
When resubmitting a claim or requesting an adjustment on a claim that is past the 90 day filing limit but
originally met the filing limit, the “TCN” which appears on the Remittance Advice (RA), will be used by
Xerox to review the claim. The provider must supply the TCN on the resubmitted claim. Do not include
the RA as an attachment.
CMS 1500 Form: Indicate the TCN in block 22 on the paper form. Leave the “Code” blank, and
indicate the TCN in the “Original Reference No.” field.
UB Form: Indicate the TCN in Form Locator 64 “Document Control Number” (DCN) matching the
appropriate payer line, using a paper form.
Dental Claim Form: Indicate the TCN on the left side in box 35 “Remarks”.
Helpful Hints:
There are two filing limits to meet - the initial filing limit and the grace period limit. Continuing to
refile a claim does not extend the filing limit. It is to the Provider’s advantage to file or request an
adjustment on the most recently filed claim that met the original filing limit.
When requesting an adjustment on an adjusted claim, use the TCN of the final payment or denial,
not the credit record which has a negative amount on the RA.
The filing limit does not apply when the provider is returning an overpayment to the Medicaid
Reconsideration Requests for non-duplicate services
When billing for multiple services on the same day, such as ambulance outpatient and bilateral services,
Providers should use a reconsideration request as proof of non-duplicate service for an initial duplicate
denial. Please see the Reconsideration, Adjustment and Void Workshop on the web portal, for additional information.
ITU Service Providers
Albuquerque Area (RAM)
March, 2016
Navajo Area Providers (BOM)
For more information or questions about IHS matters, please contact the Xerox IHS Provider Liaison:
IHS Monthly Call-in Sessions
Topic: IHS Open Forum
Date: The 2nd Wednesday of every month (February 10, 2016)
Time: 2:00 pm, Mountain Daylight Time
Meeting Number: 743 974 366
To start or join the online meeting, go to:
Teleconference information: 1-800-268-4017 Attendee access code: 816 791 7904
Staying Informed & Trained on NM Medicaid Fee for Service
Live Provider Webinar Sessions:
Are available at no cost to NM Medicaid Providers
Providers are able to attend any session.
No preregistration is required, unless stated for the specific session
Webinar Power Point Presentations are available on the New Mexico Medicaid Portal – Training
Presentations and Webinars to learn on your own and may be used as a guide or in training with your
Training Session Topic
10:00 AM
Top Ten Medicaid Denials
2:00 PM
WebEx Sign-in information is the same for all sessions
Provider Training Webinars
For assistance:
If requested, enter your name and any other requested information
Meeting Number (same for all sessions) 743 016 056
Meeting Password (same for all sessions) training
Click “Join” and follow the instructions that appear on the screen
Audio sign-on information is the same for all sessions
Dial 1-800-268-4017
Access code: 816 791 7904
Xerox Contact Information
AVRS (Automated Voice Response System) 800-820-6901
Call Center 505-246-0710 or 800-299-7304
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.