Becoming a Behavioral Health Public System Provider in New Mexico

Overview of basic steps for an individual:

  1. Completion of required training or a degree to acquire a license to practice within the field of Behavioral Health through one of the State of New Mexico Licensing Boards as outlined by New Mexico Statute for Scope of Practice. This can include acquiring certification to provide services within a specific type of facility/organization for a specific service as outlined in State Medicaid Regulations or other State Department specific rules.
  2. Acquire an NPI number.
  3. Acquire a Medicaid Enrollment ID number.
  4. Register and credential with CAQH.
  5. Roster with your agency’s contracted MCO(s).

1. Licensing and Certification Boards

 

Licensure Boards

New Mexico Medical Board

Board of Psychologist Examiners

Counseling and Therapy Practice Board

Social Work Examiners Board

New Mexico Board of Nursing

 

Certification Boards and Paraprofessionals

New Mexico Credentialing Board for New Mexico Professionals

Office of Community Health Workers

 

2. National Provider Identifier (NPI) by NPPES

The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated the adoption of standard unique identifiers for health care providers and health plans. The purpose of these provisions is to improve the efficiency and effectiveness of the electronic transmission of health information. The Centers for Medicare & Medicaid Services (CMS) has developed the National Plan and Provider Enumeration System (NPPES) to assign these unique identifiers. Visit the NPPES website.

3. Medicaid Enrollment ID

The process of acquiring a State of New Mexico provider Medicaid ID is done through the Medical Assistance Division (MAD) Medicaid Portal (Xerox). If the application is completed with all the required information, the process should take no more than 7-10 business days. Visit the website here.

4. Provider Credentialing with CAQH

Provider credentialing is a process that is done through the CAQH Universal Provider Datasource (CAQH ProView—developed by the Council for Affordable Quality Healthcare). This is a combined effort and requirement between the MCOs and CAQH. All MCOs will require credentialing. Their process can take upwards of 45 days provided that the credentialing information is complete. 

Completing the online form requires five steps:

  1. Register with CAQH ProView.
  2. Complete the online application and review the data.
  3. Authorize access to the information.
  4. Verify the data and/or attest to it.
  5. Upload and submit supporting documents.
5. Rostering with MCOs

The MCOs each have a provider network manual or handbook that should be consulted as to the appropriate path to rostering providers within an organization. Generally this is done through the CEO or assigned administrative personnel between an agency and the contracted MCO. All MCOs have a common form to roster clinicians who are credentialed to render services under public funds.