The Behavioral Health Services Division (BHSD) and the Children, Youth and Families Department (CYFD) utilize State and Federal funds to pay for services administered by our provider network.  The Behavioral Health Collaborative is the payor of last resort for behavioral health services for adults and children covered by Medicaid. When a Medicaid covered service is provided to a Medicaid eligible client, those services must be billed to Medicaid. Effective use of federal Medicaid funds allows the State greater opportunity to devote its own funds to New Mexico priorities.

As of June 30, 2020, all vendors/providers who receive funds from BHSD and provide services that are a covered Medicaid benefit, as defined in NMAC 8.321.2 and the Behavioral Health Policy and Billing Manual, must be enrolled as an approved Medicaid provider in order to receive payment. This includes services like Applied Behavior Analysis (ABA), Adult Accredited Residential Treatment Centers, and Opioid Treatment Programs (OTP). These services must be billed to the Managed Care Organizations (MCOs) or Fee for Service (FFS) Medicaid. FFS is billed through Conduent.

This does not mean that programs and services that require anonymity (e.g., domestic violence, sexual violence, shelters, etc.) will be billed to Medicaid. This does not apply to providers and agencies receiving funds under BHSD Prevention programs or CYFD JJS programs. There are no changes in billing for these providers or agencies .

It is the vendor’s/provider/s responsibility to determine eligibility of the client at the time service is rendered. Vendors must check the Medicaid portal prior to delivering a service. If the client is enrolled in one of the three Medicaid managed care organizations (BCBS, Presbyterian or Western Sky), services must be billed to the appropriate MCO. If the client is enrolled in fee-for-service Medicaid, services must be billed to Conduent. Only when neither option is available – or when a service is not covered by Medicaid or require anonymity - can a service be billed to the Behavioral Health Collaborative for non-Medicaid funding.

Thank you for complying with this contract requirement. Failure to comply may be grounds for termination.

For provider enrollment assistance, contact Marni Trujillo, Provider Enrollment for BH providers at Conduent or 505.246.9988 x 8138703.

For questions about fee for service claims, contact Shelly Begay, Program Relations Manager at Conduent or 505-246-9988 ext 8138715.

For questions regarding this alert, please contact Dauna Howerton, Quality and Compliance Manager for BHSD at Da .
Thank you,
BHSDStar Support

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