Standard Transaction Companion Guides
New Mexico Medicaid is publishing its HIPAA Transaction Companion Guides for New Mexico Fee for Service providers, vendors, billing service agencies and clearinghouses, and for New Mexico Salud! Managed Care Organizations. These companion guides will also be available on the ACS web site and the New Mexico HIPAA DESK. Companion guides in black print are not yet available; please check back often for updates.
The New Mexico HIPAA DESK is a website that will be made available for testing of HIPAA transactions to providers who submit electronic claims directly, and to billing service agencies and clearinghouses that submit claims for providers & providers that use Payer Path to submit claims will not test using HIPAA DESK. Their testing will occur within the Payer Path software.
The Companion Guides contain only those specifications unique to New Mexico and
must be used in conjunction with the
HIPAA Implementation Guides to ensure that the
HIPAA transaction meets all format and content requirements.
Providers who will use the State's new web-based claims entry software to submit
837 transactions should review the Companion Guides to ensure that correct New Mexico
specific values are used.
Please contact hsd.hipaa@state.nm.us
if you have questions about these Companion Guides.
Managed Care Companion Guides
The New Mexico Medicaid Managed Care Companion Guides have been updated to include NPI requirements. Please be aware of the following:
For all HealthCare providers, the submitter is required to report a provider in the NM1 segment with the qualifier 'XX' and an NPI number to identify that provider. The IG requires that you enter a value of 'EI' or 'SY' in the subsequent REF01 qualifier. Only 'atypical' providers can be reported with a value of '24' or '34' in the NM108 qualifier, with the provider's FEIN or SSN # in the NM109 field.
- Payment Order/Remittance Advice - Transaction not yet finalized
- Benefit Enrollment & Maintenance - Transaction not yet finalized
- Health Care Claim: Dental
- Health Care Claim: Professional
- Health Care Claim: Institutional
NCPDP 1.1/5.1 Pharmacy Encounter Payer Sheet & Supporting Document
NM Medicaid Fee For Service Companion Guides & Updates
April, 2007: The New Mexico Medicaid FFS Companion Guides have been updated to include NPI requirements. Please be aware of the following:
- For all HealthCare providers, the submitter is required to report a provider in the NM1 segment with the qualifier 'XX' and an NPI number to identify that provider. The IG requires that you enter a value of 'EI' or 'SY' in the subsequent REF01 qualifier. Only 'atypical' providers can be reported with a value of '1D' in the REF01 qualifier, with the NM Medicaid ID # in the REF02 field.