New Mexico Medicaid Portal
Contact Us
Home
INFORMATION
WEB REGISTRATION
PROVIDER ENROLLMENT
Testing
session node
::
env
production
DB
MMIS DB
Claims Temp
Timeout
Test Timeout to 1 second
Test Timeout to 10 seconds
Test Timeout to 30 seconds
Timeout:
writeToLog
Provider Enrollment
Application Setup
Select An Application Type
Billing (MAD 335)
This agreement is for groups, organizations, or individual applicants to whom payments will be made. If the applicant is an individual applying for a provider number only for identifying services billed through a group practice or other organization and payments will be made to that group or organization, then this form should not be used. Use Form MAD 312 instead.
Fee-For-Service (FFS) and Managed Care Organization (MCO) network or Fee-For-Service (FFS) only.
New Mexico Medicaid general Provider Policy (NMAC 8.302.1) requires that a provider must be enrolled in Electronic Fund Transfer (EFT) in order to receive Fee-for Service (FFS) reimbursement. You have the ability to include EFT information with your provider enrollment application. EFT is required to be an active Medicaid provider.
Managed Care Organization (MCO) network only.
Service-only (MAD 312)
This agreement is for individual applicants who perform services within a group or other organization. Payments will be made only to the group or organization. No payments will be made directly to the individual. If the applicant will be providing services for which payments are to be made directly to the applicant, then this form should not be used. Use Form MAD 335 Instead.
Fee-For-Service (FFS) and Managed Care Organization (MCO) network or Fee-For-Service (FFS) only.
Managed Care Organization (MCO) network only.
MCO Restricted
Select if you are an MCO registering a restricted provider.
MAD 012 (groups, organizations, facilities, or individual providers to whom payments are made)
MAD 013 (individual providers rendering services as part of a group or organization)
Presumptive Eligibility Determiner (MAD 219)
Select if this application is for a Presumptive Eligibility Determiner or Provider.
This Application Is :
Initial Enrollment
Select to complete a new application for the NM Medicaid program.
Re-enrollment
Select if you were previously enrolled in the NM Medicaid program.
