New Mexico Medicaid Portal



New Mexico Medicaid E-NewsNew Mexico Medicaid E-NewsDecember 29, 2022Featured Updates and Notifications:4th Quarter 2022 New HCPCS Codes Implemented - NewICD 10 Diagnosis and Surgical Code FFY 2023 Update - New2023 Gross Receipts Tax Update - NewPharmacist Enrollment Mandate and Guidance Paper Claims Billing Reminders Important Notice Regarding Taxonomy FY2023 DRG Version 40 Grouper DelayMonthly IHS Open ForumNew Mexico Medicaid Provider Resource List4th Quarter 2022 New HCPCS Codes ImplementedThe new 4th Quarter 2022 HCPCS codes, effective 10/1/2022, have been implemented into production as of 12/13/2022. Claims submitted with these codes will be mass adjusted.December 2022 ICD 10 Diagnosis and Surgical Procedure Code FFY 2023 UpdateAs of 10/5/2022, Conduent has implemented the ICD-10-CM diagnosis and PCS surgical procedure code updates. The changes are effective October 1, 2022. Any claims submitted before the implementation will be mass adjusted.December 2022 2023 Gross Receipts Tax UpdateThe Gross Receipts Tax rates for the counties and cities below have been updated. The new rates are effective on January 1, 2023. The tax rate schedule is available on the NM Taxation & Revenue website: County: Lake Arthur 7.4583%Luna County:Deming 8.3750%San Juan County:Kirtland 6.9375%Sierra County:Truth or Consequences 8.5000%Taos County:Picuris Pueblo6.8750%Questa7.9375%Red River8.8000%Taos (city)8.0625%Taos Pueblo6.8750%Taos/Taos Pueblo8.0625%Taos Ski Valley8.8125%Remainder of County6.8750%December 2022Pharmacist Enrollment Mandate and GuidancePrescribing pharmacists are reminded of an upcoming deadline for a federal requirement requiring New Mexico Medicaid to deny pharmacy claims for drugs or other items when the prescribing provider is not enrolled in NM Medicaid (either with Fee-For-Service Medicaid or with a Managed Care Organization).Both Pharmacist Clinicians and Pharmacists with prescriptive authority who bill Medicaid are required to be enrolled in Medicaid per CMS guidelines. For the time being, claims will be flagged at point of sale and Medicaid will be providing education on the enrollment process. In early 2023, if providers are not enrolled, claims will be denied.November 2022Paper Claims Billing RemindersPaper claims require a valid attachment. Clean paper claims are no longer accepted.Paper claims must be submitted on commercially printed forms from a document supplier. Printed or black and white claim forms are not accepted and will be returned.CMS claims require the service line dates to have a two-digit year – example 10/01/22. Claims with a four-digit year – example 10/01/2022 cannot be processed and will be returned.Reconsideration forms must be submitted with a completed claim form. A reconsideration form submitted by itself will be returned to the provider.The grace period for resubmitting denied claims is 90 days from the remittance date of the denial. Please remember to enter the denied TCN on the new claim for proof of timely filing.November 2022Important Notice Regarding TaxonomyEffective immediately, all MAD 012, 013, 312, and 335 applications will require a primary taxonomy. The primary taxonomy should match the taxonomy registered with the National Plan & Provider Enumeration System (NPPES) note, if the taxonomy is not listed in the dropdown list on the Web application, please select the next closest. Application taxonomies are based on provider type, not specialty.October 2022FY2023 DRG Version 40 Grouper DelayAttention Inpatient DRG Paid Providers:Because of necessary system upgrades, there will be a delay in Conduent implementing the FY2023 MS DRG Version 40 grouper software (effective October 1, 2022 through September 30, 2023) which affects hospital discharges that are paid via the diagnosis related group (DRG) methodology. Please continue to submit your claims as appropriate and any impacted claims will be automatically reprocessed once the charges are implemented. In the meantime, your claims will continue to process under the current MS DRG version 39. Please look for future updates.October 2022Monthly IHS Open ForumThe monthly IHS Open Forum is available for all IHS and Tribal 638 staff. The forum is on the second Wednesday of every month from 2:00 to 3:00 pm Mountain time. Microsoft TEAMS meeting - Click here to join the meeting Join by phone (audio) – 1-585-420-6781, conference ID 402 213 551#New Mexico Medicaid Provider Resource ListNew Mexico Medicaid Portal - Claim Inquiries, Eligibility verification, Electronic claim submission, Provider manuals, E-NewsMedical Assistance Division Program Rules - NMAC for programs administered by the Medical Assistance DivisionNM Human Services Department - Supplements, Memos, Provider Billing Packets and PolicyConsolidated Call Center – (800) 299 – 7304Provider Inquiries email: NMProviders@state.nm.usMember Inquiries email: NMMembers@state.nm.usHIPAA Inquiries link: HIPPAA.DeskNM@state.nm.us EDI or Portal Password ResetsDisclosure – The objective of the E-News, training, and webinars is to inform and educate. Articles reflect information at the 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 is available on the NM Medicaid Web Portal. ................
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