Credentialing for new providers to end in April 2023

Please note that we will not credential any new providers after April 1, 2023. If your practice has providers starting before June 30, 2023, those providers will need to notify us at [email protected] and get the credentialing process started as soon as possible. Thank you for your cooperation.

Continue to check eligibility and benefits for THNM members

Please keep in mind that you may continue to have patients who have group coverage with True Health New Mexico through June 30, 2023. Always check your THNM patients’ eligibility and benefits. Do not turn away any patients who are still covered under a group plan.

Here are some important dates to remember.

• All THNM individual and family plan coverage will end on December 31, 2022.
• THNM coverage for Albuquerque Public Schools members will end on December 21, 2022.
• Small-group and large-group THNM coverage will end on or before June 30, 2023.

2023 changes to list of drugs covered under the medical benefit

There will be changes to the coverage status for some medical benefit drugs on January 1, 2023. Please see the table below for details.

2023 changes to small- and large-group formulary

• Find a list of small-group formulary changes here.
• Find a list of large-group formulary changes here.
• Be sure to visit our Pharmacy/Formulary page on/after January 1 for our current formularies, $0 copay drug lists, and much more.

Important information about Doctor On Demand® services

Upon the end of our members' True Health New Mexico plan coverage, Doctor On Demand by Included Health will no longer be a covered service.

• Individual and family plan and APS members' Doctor On Demand coverage will end along with their True Health New Mexico plan coverage on December 31, 2022.
• Large and small group plan members will have Doctor On Demand coverage through June 30, 2023.

Once our members' Doctor On Demand coverage ends, they can continue using these services and seeing the same board-certified providers, but they will be required to pay out-of-pocket for each visit. Find specific cost details on the Doctor On Demand website.

Reminders for smooth claims processing

New vendor for electronic claim submission effective December 1, 2022

True Health New Mexico’s third-party administrator, Evolent Health, began using a new vendor for electronic data interchange (EDI) claim submissions on December 1. Read the notice on our website for details.

Send your claims to the right address

As we wind down our operations in 2023, we want to remind all providers to send their paper claims to to the correct address.

• Please refer to our Claims and Eligibility Reference Guide for the correct claims address for individual, small group, large group, and federal employee claims. 
• NEW: All federal employee (FEHB) paper claims should be sent to our headquarters: True Health New Mexico, Attn. FEHB Claims, P.O. Box 37200, Albuquerque, NM 87176.

How to avoid claim denials

To avoid denials and speed up reimbursement, please follow these guidelines.

• There are different payor ID numbers for individuals, small groups, large groups, and Albuquerque Public Schools.
• Identify the correct payer ID by reviewing the member and group IDs found on the member’s ID card.
• Click here to view and download a visual guide to our different subscriber ID cards.
• Download our Claims and Eligibility Reference Guide.

True Health New Mexico | 1-844-508-4677| truehealthnewmexico.com