Important reminder for all providers and office staff about True Health New Mexico plans in 2023

New vendor for electronic claim submission effective December 1, 2022

True Health New Mexico’s third-party administrator, Evolent Health, will begin using a new vendor for electronic data interchange (EDI) claim submissions. If you file claims electronically, here’s what you need to know.

• There is no change in payer ID number. Please continue to send claims to the payer ID 82288.
• The new EDI vendor is called Availity® and the change goes into effect on December 1, 2022.
• Many of our providers are already registered to use the Availity portal. If you aren’t registered, you will need to do so before you can file claims. Registration instructions are below.

Providers that submit paper claims are not affected by this change.

How to register for the Availity portal

1. Go to www.availity.com.  

2. Click Register and complete the process.

3. For registration guidance or tips, we recommend you refer to the following resources before starting your registration application:

• Register and Get Started with Availity Portal microsite 
• EDI Quick Start Guide for Availity 
• Submitting a Claim on Availity Essentials

4. If an organizational account exists, you will get a notification during the registration process asking if you wish to proceed.

5. If you have questions, call Availity Client Services at 1-800-282-4548. They will walk you through this process or answer any questions you have about the portal.

6. After completing registration, download Availity’s handout, Use Availity Essentials to Submit Professional Claims, for additional help. 

Make sure you're sending your claims to the right address

As we prepare to wind down our operations in 2023, we want to remind all providers to send their 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) claims should be sent to our headquarters: True Health New Mexico, Attn. FEHB Claims, P.O. Box 37200, Albuquerque, NM 87176.

When we receive claims in our office that should have been mailed to Eagan, MN, we mail them to the correct address as a courtesy to you. Eventually, we will stop doing this, so please check your systems and update your claims address for True Health New Mexico now. Download the Claims and Eligibility Reference Guide at the link above.

Better yet, file your claims electronically! Refer to our Provider Handbook for information on e-filing. 

Avoid claim denials: Use the correct payor ID

A common mistake that causes claims to be denied is not using the correct payor ID number for the patient's True Health New Mexico plan. To avoid denials and speed up reimbursement, please follow these tips.

• There are different payor ID numbers for individuals, small groups, large groups, Albuquerque Public Schools, and federal employees.
• 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.
• If the group ID begins with FB00, the claim must be submitted to the payer ID for Federal Employee Health Benefits (FEHB) claims, 85824.
• Download our Claims and Eligibility Reference Guide.
• Failure to follow these guidelines will result in claim denial.

Some patients report being turned away by in-network providers

We have learned that some contracted providers have turned away True Health New Mexico members in error, stating that the provider's contract is no longer in effect. True Health New Mexico is still in business, and as long as a patient's THNM coverage is in effect, providers are not permitted to turn them away because the provider is contractually obligated to honor the contract until it is formally terminated.

If you have questions about THN plans in 2023, please click on the "important reminder" hyperlink at the top of this email. If you have questions about your provider contract, please visit the Providers page of our website to find a list of Provider Services representatives. 

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