Please follow the Enrollment Instructions below to become an electronic submitter for New Mexico Medicaid.

Required Documents for those applying for new Submitter IDs

The following documents are required enrollment documents that must be completed, signed and returned to the Medicaid office prior to initiation of electronic claims submission or inquiry.

1. Trading Partner Agreement
2. New Mexico Medicaid Provider Billing Agent Form (for Billing Services)


If the links listed above do not work properly, please download these forms from here:
https://nmmedicaid.acs-inc.com/nm/general/loadstatic.do?page=ProviderInf...

If you have any questions regarding any of the documents in this package, please call the Medicaid EDI Technology Support Center at 1-800-299-7304 and ask for the EDI Help desk.

We can now process 276/277 requests (claim status). If this is a transaction you would like to utilize please make sure to enroll with the payer.

Trading Partner Agreement

Header

• Enter your Provider number and NPI

• Enter your Tax ID or Social Security Number

• Please enter your name

• Enter your legal business name and DBA if applicable

• If you are hospital, enter your information in the next section

• Please leave the very bottom space blank

• On the next page, please enter your mailing address, phone, and fax number

• Please enter contact information for your primary and secondary contact in your office

• Select the following

  • X12N 837 (Professional Claims) for CMS-1500 billings

  • X12N 837 (Institutional Claims) for UB04 billings

  • X12N 835 (Claim Payment Advice) for your Electronic EOBs

  • X12N 277 CA (Payer Specific Reject Report)

  • X12N 999 (Acknowledgment of Sent Transactions)

• On the following page, please enter your Provider Name and NPI

• On Page 12 please enter your Provider Name, Signature, Individual Name, Title, NPI and Date

New Mexico Medicaid Provider Billing Agent – Submitter Application

(For Billing Service’s)

• Please check the box for Billing Agent

• Please enter your Business Name, Address, Phone, Fax and Email

• Please leave the Trading Partner ID Number section blank

• Please leave the Clearinghouse/Vendor name section blank

• Enter the name, demographic, and contact information for the contacts in your office

• • Select the following

    • X12N 837 (Professional Claims) for CMS-1500 billings

    • X12N 837 (Institutional Claims) for UB04 billings

    • X12N 835 (Claim Payment Advice) for your Electronic EOBs

    • X12N 277 CA (Payer Specific Reject Report)

    • X12N 999 (Acknowledgment of Sent Transactions)

   

• Please Sign, print Name and Title, and enter today's Date

Submitting your Forms

It is recommended that you keep a copy of all the forms you will be submitting for your records. Please mail the Trading Partner Agreement reflecting original signatures to:

Conduent State Healthcare, LLC
P.O. Box 27460
Albuquerque, NM 87125-7460

Or fax to: 1-866-226-1473

It is very important that you complete and return the entire enrollment packet as described above. Incomplete packets will not be processed and will be returned to the submitter.

Waiting for a Response

Once the complete provider enrollment packet has been received, the documents will be processed. Processing will take approximately two weeks from the date of receipt. (Remember that mailing time can take as much as five days.)

After processing, a confirmation will be e-mailed to you as notification to begin filing claims electronically. If neither confirmation nor a returned packet is received after two weeks, contact the Technology Support Center toll-free at 1-800-299-7304 and ask for the EDI Help desk.

Testing

Once you have received your Submitter ID and Password from Medicaid, please call the ClaimShuttle Support Team and set an appointment for a Mailbox setup and Test Transmission to Medicaid.

Please have 3 files, in each file 10 test claims, ready for testing. Test files should consist of a variety of claims that represent the type of claims you will be submitting once production status is achieved. Test claims will not be processed for payment but will be validated against production files; therefore, they must contain valid patient procedure, diagnosis, and provider information.