New Mexico Medicaid Requires State Enrollment for Claim Payments
New Mexico Medicaid Requires State Enrollment for Claim Payments
Effective for dates of service on or after July 01, 2026, New Mexico Medicaid will deny claims if the attending, referring, ordering, or prescribing provider is not enrolled with Medicaid.
This requirement applies to all U.S. care providers and pharmacists who provide services to Medicaid members. Providers should complete enrollment before the effective date to avoid claim denials.
Enrollment instructions are available through the New Mexico Health Care Authority (HCA) Providers Overview: Ordering, Referring, Prescribing page. Providers are encouraged to apply early, as HCA may need time to process applications before July 1, 2026.
Who Needs to Enroll?
This requirement applies to all providers and pharmacists, including those working in:
- Individual practices
- Group practices
- Hospital systems and facilities
- Behavioral health agencies
- Indian Health Service programs
Information to Include on Claims
Claims should include the following details:
- National Provider Identifier number
- Tax identification number
- Payer ID 87748
- Use payer ID 87726 for electronic visit verification claims
Why Enrollment Is Required
Medicaid enrollment allows the state to verify provider credentials, keep provider records up to date, and ensure payments are made only for services ordered, prescribed, or delivered by qualified enrolled providers.
Questions?
Providers can review the HCA frequently asked questions or contact HCA Provider Enrollment at 800-299-7304 or nm.providers@hca.nm.gov.
