Reinforce Prenatal and Postpartum Care To Support Whole Health

We track quality measures related to our members’ care visits and depression screening during and after pregnancy. Review tips to close gaps in care.

See Our Behavioral Health Resources for Providers

Resources for providers across disciplines include clinical practice guidelines and information on quality measures, as well as introductory webinars offering continuing education credit at no cost to you.

See Prior Authorization Changes for Some Commercial and Government Program Members

We’ve updated prior authorization requirements for certain commercial and government plans to reflect new, replaced or removed codes.

Watch for Claim Editing Changes for Evaluation and Management Services for Commercial Members

Effective July 1, 2026, we’ll enhance our claims editing and review process for office, inpatient and outpatient evaluation and management services for our members with commercial plans.

Two New Claims Editing Rules To Be Implemented in July 2026

On or after July 8, 2026, we’ll update the Lyric software database to better align provider coding with industry standards for accurate billing and proper reimbursement.

Explore Learning Opportunities

We offer free training for providers who participate in our networks. View and sign up for training sessions, including a new course on youth behavioral health.

Use Updated Hospital Forms for Medicare Members

The Centers for Medicare & Medicaid Services updated its Important Message from Medicare and Detailed Notice of Discharge. Learn how to access the forms.

See Changes to Our Annual National Drug Code Fee Schedule, Impact and Timeline

We review our NDC Fee Schedule on an annual and periodic basis. Reimbursement rates for some medications may change because of this review.

Review Pharmacy Program Quarterly Update – Part 2

Changes were made to our drug lists and utilization management program. Learn about these and other pharmacy program updates.

Learn About Updates to Reimbursement Policies

We regularly add and modify reimbursement policies, formerly known as clinical payment and coding policies, as part of our ongoing policy review. See which policies were updated.

Review Active and Pending Medical Policies

Approved new or revised medical policies and their effective dates are usually posted on our website the first and 15th of each month. You can view all active and pending policies, as well as draft medical policies, and provide comments on draft policies. These policies may impact your reimbursement and your patients’ benefits.

Review Updated Claims Processing Information for Turquoise Care

The New Mexico Health Care Authority launched  Turquoise Claims on March 23, 2026, replacing Omnicaid and the New Mexico Medicaid Portal.

Follow Taxonomy Code Attestation Requirements To Avoid Medicaid Claim Rejections or Denials

To align with New Mexico Medicaid billing requirements, it’s important that you submit claims with appropriate taxonomy codes to identify the provider type and specialty. As of March 23, 2026, failure to report the appropriate taxonomy code will result in claim rejections or denials.

Medicaid Providers Are Required To Register with Turquoise Care

Effective July 1, 2026, providers should ensure they are registered with Turquoise Care if they render or bill for Medicaid services to prevent claim denials.

Register for 2026 Critical Incident Reporting Training

We’re offering the annual training required for Turquoise Care providers several times throughout the year. See what it covers and how to register.