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Notice to Non-Participating Behavioral Health Providers submitting claims to United Healthcare Community Plan of New Mexico for the New Mexico Centennial Care Behavioral Health Program

The minimum claims submission requirements for United Healthcare Community Plan of New Mexico are listed below. Claims submission from a non-participating provider (to include out-of-state providers) must meet these requirements to be eligible for payment. New Mexico Centennial Care’s Behavioral Health program has strict rules on the types of providers allowed to render services to Managed Medicaid consumers. (See lists below).

In accordance with the New Mexico Human Services Department (HSD), reimbursement for non-participating provider claims will be at 95% of the State of New Mexico rates. Behavioral health reimbursement rates can be found at United Healthcare Community Plan of New Mexico will only reimburse for procedure codes and services that are a part of the covered benefit.

Approved New Mexico Centennial Care Provider Types:

Independent Practitioners

·         Individuals licensed as psychiatrists 
·         Psychologists (Ph.D., Psy.D. or Ed.D.) 
·         Licensed Independent Social Workers (LISW) 
·         Licensed Professional Clinical Mental Health Counselor (LPCC) 
·         Licensed Marriage and Family Therapists (LMFT) 
·         Individuals Licensed Clinical Nurse Specialists or Certified Nurse Practitioners


Agencies - that bill for non-independent practitioner services

·         Community Mental Health Centers (CMHC) 
·         Federally Qualified Health Centers (FQHC) 
·         Indian Health Service (IHS) Hospitals and Clinics 
·         PL-638 providers 
·         Children, Youth and Families departments (CYFD) 
·         Hospitals and their Outpatient Facilities 
·         Core Service Agencies (CSA)

Facilities/hospital-based providers that offer inpatient or higher levels of care

·         Community Mental Health Centers (CMHC) 
·         Inpatient Facilities 
·         Rural Health Clinics (RHC) 
·         Federally Qualified Health Centers  (FQHC) 
·         Substance Use Disorder Agencies (SUD) 
·         Core Service Agencies (CSA) 
·         Indian Health Services / PL - 638 Providers 
·         School Based Health Clinics  (SBHC) 
·         Residential Treatment Centers (RTC) 
·         Group Homes 
·         Treatment Foster Care Providers


Services Requiring Prior Authorization

·         Inpatient Psychiatric Care in a Free Standing Psychiatric Hospital & Hospital Services (Inpatient Hospitalization in Psychiatric Units) 
·         Accredited Residential Treatment Center (ARTC) Services 
·         Non-Accredited Residential Treatment Center (RTC) Services 
·         Group Home (GH) 
·         Treatment Foster Care I (TFCI) 
·         Treatment Foster Care II (TFCII) 
·         Adaptive Skills Building (ASB) 
·         ECT (University of NM only)

United Healthcare Community plan of New Mexico reserves the right to recoup payments from non-participating behavioral health providers that do not meet the minimum requirements as referenced above.  To become a participating provider of behavioral health services with United Healthcare Community Plan of New Mexico, please use the following link to contact the correct provider relation staff: Click Here for Provider Relations Staff Contact Information


HIPAA Claim Edits 

UnitedHealthcare applies HIPAA edits to professional (837p) and Institutional (837i) claims submitted electronically. Visit the EDI Claim Edits page for more information including a complete list of edits, edits related to ICD-10 codes and applicable payers.

Claims that reject for HIPAA edits will appear on a clearinghouse level report, enabling you to Identify and correct rejected Information prior to UnitedHealthcare receiving the claim.

Integrity of Claims, Reports, and Representations to the Government

UnitedHealth Group requires compliance with the requirements of federal and state laws that prohibit the submission of false claims in connection with federal health care programs, including Medicare and Medicaid. 
View our policy (PDF 38.15 KB).