New Mexico Medicaid E News
November 4, 2014
Focus On…
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Notice to Providers on NCCI and Other Topics, October 2014
Resubmitting Claims and Submitting Adjustments
Reconsideration Requests for Non-Duplicate Services
Electronic Funds Transfer (EFT) Enrollment
Rates for Hospice providers, Type 362, Increase
ICD-10 Survey
Primary Care Enhanced Payments
NM Medicaid Provider Resource list
ITU Service Providers
o Navajo Area Providers (BOM)
o Albuquerque Area (RAM)
o IHS Monthly Call-in Sessions
Staying Informed & Trained on NM Medicaid Fee for Service
o Training-Webinar Tuesday, November 11 - Direct Data Entry (DDE)
o Provider & Xerox Open forum Tuesday, November 18, at 1pm
Xerox Contact Information
Notice to Providers on NCCI and Other Topics, October 2014
Providers should review the recently released important state announcement on the National
Correct Coding Initiative (NCCI), reason and remark codes, UB claim form data elements and
other topics. The notice can be viewed on the web portal here: Important State Announcements
Please also check out these important links:
Important information regarding copayments may be found on the HSD/MAD website:
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http://www.hsd.state.nm.us/mad/CMedAssisPrograms.html
A chart with detailed copayment information may be found here:
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http://www.hsd.state.nm.us/LookingForInformation/cost-sharing-chart.aspx
You may also find this chart by visiting the MAD home page and following the steps below:
1) Click on the ‘Looking for Information’ link
2) Then Click on the ‘Information for Recipients’ link
3) Then lastly, Click on the ‘Cost Sharing Chart’ link
A chart comparing alternative benefit plans services to those provided under the state plan,
including information on copayments, can be found here:
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http://www.hsd.state.nm.us/LookingForInformation/client-co-payments.aspx
You may also find this chart by visiting the MAD home page and following the steps below:
1) Click on the ‘Looking for Information’ link
2) Then click on the ‘Information for Recipients’ link
3) Then lastly, click on the ‘Alternative Benefit Plan vs. State Plan Comparison
Chart’ link
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.
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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.
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UB Form: Indicate the TCN in Form Locator 64 “Document Control Number” (DCN)
matching the appropriate payer line, using a paper form.
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Dental Claim Form: Indicate the TCN on the left side in box 35 “Remarks”.
Helpful Hints:
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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.
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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.
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The filing limit does not apply when the provider is returning an overpayment to the
Medicaid program.
Reconsideration Requests for non-duplicate services
When billing for multiple services on the same day such as ambulance outpatient and bilaterial
services. Providers should use a reconsideration request as proof of non-duplicate service for
an initial duplicate denial. Please see Reconsideration, Adjustment and Void Workshop on the
web portal, https://nmmedicaid.acs-inc.com/static/ProviderInformation.htm
for additional information.
Electronic Funds Transfer (EFT) Enrollment
As stated in section NMAC 8.302.2.9, “MAD or its selected claims processing contractor
issues payments to a provider using Electronic Funds Transfer (EFT) only. Providers
must supply necessary information in order for payment to be made.”
Signing up for EFT is easy – just go to the New Mexico Web Portal at
https://nmmedicaid.acs-inc.com.
If you need additional assistance, please contact the Provider Relations Call Center at
800-299-7304 and pressing option 5 and then option 6 for questions and assistance.
Electronic Funds Transfer (EFT)
Benefits you and New Mexico taxpayers by:
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Improve your cash flow and receive money earlier through direct deposit
Providing greater security and low risk for direct deposits
Eliminating lost and stale dated checks
Reducing Medicaid administrative costs
Effective July 1, 2013 providers must be enrolled in EFT. The EFT process can take 2-3 weeks
to complete, so please enroll today!
Rates for Hospice Providers, type 362, Increase
Rates for hospice providers, Type 362, are loaded in Omnicaid by provider number, based on
facility location for revenue codes 0651, 0652, 0656 effective October 1, 2014. The rate
increase is located on the web portal, Hospice Provider (Type 362) Rate Changes effective
10/01/14.
Review https://nmmedicaid.acs-inc.com/static/ProviderInformation.htm to see the rates.
ICD-10 Provider Readiness Survey
Xerox State Healthcare, LLC (Xerox) encourages survey submissions. Survey responses will
aid Xerox in assessing any issues or concerns that may impede ICD-10 implementation. All
answered surveys will be kept confidential and anonymous.
https://www.surveymonkey.com/s/NMICD-10ReadinessSurvey
Primary Care Enhanced Payments for Provider Services
The Affordable Care Act (ACA 1202) Primary Care Enhanced Payment Program continues
through calendar year 2014. New Mexico Medicaid has paid out $3,052,128 for eligible feefor-service claims through June 30, 2014. Managed care organizations have paid an
additional $15,020,599 for encounters through December 31, 2013. Eligible providers who
self- attested and qualified for enhanced payments have been paid a total of $18,072,727.
DEADLINE DATES
HSD/MAD will continue to accept attestations forms through the remainder of calendar year
2014. Providers successfully completing the attestation process by August 31, 2014 will
receive enhanced payment for claims with dates of service between January 1, 2014 and
December 31, 2014. Providers successfully completing attestations after August 31, 2014
will receive enhanced payment for claims with dates of service of between July 1, 2014 and
December 31, 2014. Attestations received after December 1, 2014 will not be considered for
enhanced payments.
PAYMENTS
Payments are made to the provider who was originally paid for the claim (the billing provider)
even though it is always an individual provider, not a group or clinic who must qualify for the
increased payment. The payment, in most situations, must be given by the group, clinic or
billing provider to the qualifying individual provider. Where there is an employment
agreement between the physician and the employing entity, the employment agreement
might account for the payment increase by noting that the physician accepts his or her salary
as payment in full, regardless of Medicaid reimbursement levels. Any payment ultimately not
paid to a rendering provider who may have left a group or clinic and cannot be located must
be returned to HSD/MAD.
NM Medicaid Provider Resource list
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New Mexico Medicaid Portal – https://nmmedicaid.acs-inc.com/static/index.htm
Claim Inquiries, Eligibility Verification, Electronic Claim Submission, Provider Manuals, E-News
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NM Human Services Department – http://www.hsd.state.nm.us/mad/
Supplements, Memos, Provider Billing Packets and Policy
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Xerox State Healthcare, LLC: Provider Relations Call Center – (800) 299 - 7304 option 6 or (505) 246 0710 option 6. Claim Status, Eligibility, Prior Authorization, Medicaid Updates
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Xerox State Healthcare, LLC. Provider Relations Helpdesk – NMProviderSUPPORT@xerox.com
Claim research assistance and general Medicaid inquiries
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Xerox State Healthcare, LLC. HIPPA Helpdesk – HIPAA.Desk.NM@xerox.com
Assistance on NM Web Portal, EDI inquiries, and Online Claim Submission with DDE (Direct Data Entry)
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Xerox State Healthcare, LLC. Provider Enrollment Helpdesk -NMEnrollmentSUPPORT@xerox.com
Provider Enrollment Applications, Forms & Instructions
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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
ITU SERVICE PROVIDERS
Navajo Area Providers (BOM)
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BOM meeting is scheduled for November 14th, 2014
Albuquerque Area (RAM)
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Xerox will attend the November 21st meeting.
Please call the New Mexico Medicaid Call Center at (800) 299-7304 or (505) 246-0710 for more
information.
Xerox State Healthcare, LLC. IHS Provider Liaison - Erminia.Reynaga@xerox.com
IHS Monthly Call-in Sessions
Topic: IHS Open Forum
Date: The 2nd Wednesday of every month, November 12, 2014
Time: 2:00 pm, Mountain Daylight Time (Denver, GMT-06:00)
Meeting Number: 748 232 142
Meeting Password: (This meeting does not require a password.)
To start or join the online meeting, go to:
https://xerox.webex.com/xerox/j.php?ED=281512987&UID=507147327&RT=MiM2
Teleconference information: 1-800-268-4017 Attendee access code: 948 652 0769
STAYING INFORMED AND TRAINED ON NM FEE FOR SERVICE
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Training-Webinar Tuesday, November 11, 2014
Are there topics you would like to see on the webinars? We welcome your suggestions!
The webinar Power Point presentations are available on the New Mexico Medicaid Portal –
Training Presentations to learn on your own. Webinar sessions are available at no cost to NM
Medicaid Providers.
 Providers are able to attend any session
 Registration is not required (use link below)
Time
Session Topic
10:00am
UB – 04 Online Claims Entry
11:30am
CMS – 1500 Online Claims Entry
1:00pm
ADA Dental Online Claims Entry
2:15pm
DD Waiver CMS – 1500 Online Claims Entry
3:30pm
Adjustment-Void-Rebill Online claims Entry
WebEx - sign-on information is the same for all sessions
November 11, 2014--Direct Data Entry (DDE) Claims Registration & Training Session
NM Medicaid Direct Data Entry Webinar Session
For assistance: https://xerox.webex.com/xerox/mc
If requested, enter your name and any other requested information
Meeting Number (same for all sessions) 742 528 886
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: 948 652 0769
Provider & Xerox Open forum Tuesday, November 18, 2014 at 1pm
 Topics will include the top 5 claims denial (exception) codes
 No pre-registration is needed:
 For teleconference audio dial 800-268-4017, access code: 948 652 0769
 Use this link to join the webinar: Provider and Xerox Open Forum
Enter your name and email address, the meeting # 746 338 863, password: none, then
click "Join".
CONTACT INFORMATION
Email: NMPRSupport@xerox.com
Email: HIPAA.Desk.NM@xerox.com
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.