New Mexico Medicaid: State changes to claims process

Use the new payer ID code

Later this spring, New Mexico Health Care Authority (HCA) and Medical Assistance Division (MAD) is launching Turquoise Claims, the new claims management system at YES.NM.gov. The state has communicated the upcoming change to health care providers contracted with Turquoise Care managed care organizations and will inform them before the new system is in place.

New payer ID code

The payer ID code for UnitedHealthcare Community Plan of New Mexico will change on the day the state switches to the new Turquoise Claims system. We’ll send you a reminder of the change after the state sends notification of the launch date.

For a smooth transition and to avoid claim denials and delays, please follow these instructions:

Contact your clearinghouse to add payer ID 87748 to your list of electronic data interchange (EDI) transactions
When submitting claims, enter the following payer ID:
- Between now and the system launch date, continue to use payer ID 87226
- On the day of the launch, use payer ID 87748
Claims submitted with the incorrect payer ID code during these timelines will be denied and you’ll need to submit a corrected claim

No changes to claim submissions

Besides using a different payer ID code, there’s no change to the way you submit claims. You’ll follow the same process as usual, whether you file claims electronically using EDI, online through API or the UnitedHealthcare Provider Portal or by mail. The terms of your participation agreement with UnitedHealthcare Community Plan of New Mexico remain in effect and binding.

Where to get EDI support

Contact your clearinghouse if you have any questions about your EDI transactions.

Questions? We’re here to help.

Connect with us through chat 24/7 in the UnitedHealthcare Provider Portal
For questions about the Turquoise Claims systems, email HCA-TurquoiseClaims@hca.nm.gov
Go to Turquoise Claims for information updates, past communications and frequently asked questions