Credentialing in New Mexico
Soft Home Global provides payer enrollment, revalidation and follow-up for New Mexico practices and billing companies at $2,100 per seat per month. Full time, worked during New Mexico business hours, inside your own system.
What is specific to New Mexico
New Mexico is a mostly rural state where a high share of residents are covered by Medicaid, most of it delivered through contracted managed care plans rather than fee-for-service.
New Mexico’s Medicaid programme is New Mexico Medicaid (Turquoise Care). Practices with a meaningful New Mexico Medicaid (Turquoise Care) mix usually need it worked as its own queue rather than mixed into commercial follow-up, because the submission path, the timely filing window and the appeal route are all different.
What a credentialing seat does in New Mexico
Applications, revalidations and payer follow-up, with every enrollment's status visible.
New Mexico Medicaid (Turquoise Care) is not one enrollment but one per plan, and every one of them has a revalidation date that stops payment when it passes. That calendar is the work.
- Initial applications prepared and submitted
- Revalidations tracked ahead of the deadline
- CAQH kept current
- Payer follow-up until an effective date is issued
- Status of every enrollment visible to you
- Worked during New Mexico business hours, not queued overnight
For the statute behind all of this — New Mexico’s prompt-pay deadline, its Medicaid filing limit, and the wrinkle that catches people out here — see the New Mexico billing page.
New Mexico Medicaid (Turquoise Care), in practice
Near-universal managed care under Turquoise Care: "As of July 1, 2024, Turquoise Care members can choose from among four health plans, (also called Managed Care Organizations or MCOs)" — Blue Cross Blue Shield of New Mexico, Molina Healthcare, Presbyterian Health Plan and United Healthcare Community Plan; the same page adds "Children in state custody will be enrolled in the Presbyterian Health Plan" and "Native American members always have the choice between enrolling with a health plan or using Fee for Service health care providers." Source
Working New Mexico hours
New Mexico runs on Mountain time, 12 hours behind our floor in Rawalpindi. To be at a desk for your nine to five, the shift here runs 9pm to 5am, and 8pm to 4am once the clocks go forward. Pakistan does not observe daylight saving, so the shift moves on this side rather than yours.
That is the part that decides whether follow-up happens at all: a payer’s phone lines are open on New Mexico hours and nobody else’s.
What it costs in New Mexico
$2,100
Per seat, per month, in US dollars — $25,200 a year for one full-time person, forty hours a week, on New Mexico hours. No annual contract, no percentage of collections, no setup fee and no software to buy. Seat prices across all roles in New Mexico run $1,450 to $2,400; the full list is published.
That is the entire invoice. Run your own figures against a percentage vendor or a hire rather than take ours.
Getting started in New Mexico
About a week from a signed agreement to a person working your queue, and that week of training on your workflow is not billed on top. The work happens in your own system under a login you issue, so there is nothing to migrate and nothing to install. The week, step by step, and what is signed before anyone has access.
Questions
Do you work with New Mexico practices?
Yes. New Mexico accounts are worked during New Mexico office hours rather than queued overnight, because a payer's phone lines are open then and at no other time.
What is different about New Mexico?
New Mexico is a mostly rural state where a high share of residents are covered by Medicaid, most of it delivered through contracted managed care plans rather than fee-for-service.
How long do we have to file a New Mexico Medicaid (Turquoise Care) claim?
90 calendar days from the date of service, measured from the date of service. A returned, denied or incorrectly paid claim: resubmit within 90 calendar days of the return, denial or payment. Past that date a claim is not late, it is unpayable, and no appeal recovers it. Source: 8.302.2.11 NMAC — Billing and Claims Filing Limitations.
When does a New Mexico payer have to pay a clean claim?
30 days for electronic clean claims; 45 days for manually (paper) submitted clean claims A claim sitting past that is not merely late, it is late against a statute, and the follow-up call changes from "when might this be paid" to "this passed your statutory window on a specific date".
How much does credentialing cost in New Mexico?
$2,100 per seat per month — $25,200 a year for a full-time person, forty hours a week. Every seat price is published at softhomeglobal.com/pricing.
What hours will somebody actually be working our New Mexico queue?
New Mexico is on Mountain time, 12 hours behind Rawalpindi. The shift here runs 9pm to 5am so your seat is at a desk for your full working day, shifting to 8pm to 4am while daylight saving is in force — Pakistan does not observe it, so the change happens on our side.
Do you handle New Mexico Medicaid (Turquoise Care) as well as commercial payers?
Yes, and as its own queue rather than mixed into commercial follow-up. New Mexico Medicaid (Turquoise Care) has its own submission path, its own filing window and its own appeal route, and working it in the same worklist as commercial claims is how the deadlines get missed.
Is this a percentage of what you collect?
No — a flat monthly rate per seat, published at softhomeglobal.com/pricing. A percentage bills you most in your best month and points the vendor at the easy accounts.
What is the minimum commitment, and how quickly can somebody start?
One seat for one month, cancellable on thirty days notice, and about a week from a signed agreement to a person working your queue. The week of training is not billed. The steps are at softhomeglobal.com/how-it-works.
Is our patient data safe offshore?
A Business Associate Agreement is signed before anyone has access, and the work happens in your own system under a login you issue, so every action is attributable to a person in your audit trail. The controls are listed at softhomeglobal.com/security.
Next step
One seat on your New Mexico work
Twenty minutes on a call is enough to tell whether this fits. If it does not, I will say so.
Or write to ops@softhomeglobal.com