Learn more about the options available to provide quick and accurate claims processing at Presbyterian.
NEW MEXICO MEDICAID PROVIDER TYPES AND TAXONOMY CODES REFERENCE GUIDE
Providers who have multiple provider types associated with their National Provider Identifier (NPI) number are required to submit claims using the correct taxonomy code that corresponds with the specific provider type for the services that they are billing. Providers may use this reference guide to view the taxonomy codes that the New Mexico Human Services Department (HSD) assigned to each provider type.
ELECTRONIC PAYMENT - PRESBYTERIAN EPAYMENT CENTER
Presbyterian offers electronic remittance advice/electronic funds transfer (ERA/EFT) transactions at no charge to contracted medical providers.
Providers may enroll in Presbyterian’s electronic payment (ePayment) portal by visiting the following link
Should providers have any questions about this service, or should they require additional assistance, they may contact our ePayment Client Services team at
or by email at Help@ePayment.CenterSUBMITTING CLAIMS ELECTRONICALLY
Electronic claims transmission (ECT) saves time and money and helps make the claims process as efficient as possible. Here are some other benefits of submitting claims electronically:
The average time to process and electronic claim is seven days, compared to 14 days for paper claims.
You save the cost of postage and paper when you submit electronically.
Your office receives a quicker confirmation of claims receipt and integrity of the data.
There is a higher percentage of claims accuracy, resulting in faster payment.
Fast Claim is designed to accommodate lower volume claim submitting practices that would like to submit claims electronically directly to Presbyterian at no cost. For questions, contact your relationship executive.
To learn more about ECT, please refer to the Claims Section of the Provider Manual or contact your Provider Network Management relationship executive.
RECOVERY OF CLAIM OVERPAYMENTS
Presbyterian occasionally recovers claim(s) overpayments through Explanation of Payment (EOP). Presbyterian will pursue the recovery of claim(s) overpayments when identified by Presbyterian or another entity other than the practitioner, physician, provider, or representative. Other frequent terms used for claim(s) overpayments are: “recoupment,” “take back,” and “negative balance.” If you need assistance filing a recovery of claim(s) overpayment, please refer to the manual.
HELP FILLING OUT CMS 1500 AND UB-04 CLAIM(S) FORMS
For more guidance on filling out CMS 1500 (02/12) and UB-04 claims forms, you can refer to:
THE NO SURPRISES ACT: OPEN NEGOTIATION REQUEST PROCESS
The No Surprises Act of 2020 created legislation to protect patients from surprise balance billing. The negotiation process is specific to out-of-network claims that are covered under the No Surprises Act.
To learn more and to view the forms that must be completed to initiate the negotiation process, please see the materials below.
CORRECT CODING MEDICAL REVIEW GUIDES
To ensure that providers are kept up-to-date regarding coding changes and claims edits, Presbyterian is providing guides that summarize these updates as they occur. For the most current information on payment and claims edits, view the guides below.
MEDICAID ENROLLMENT GUIDELINES
All individual and group providers are required to enroll with the New Mexico Human Services Department (HSD) to order, refer, prescribe or render services to Centennial Care members to ensure timely claims payments. Without enrollment, claims may be denied.
CONTRACTED CLEARINGHOUSES
Contact our contracted Clearinghouses to see which one is the best fit for your practice management system.
