Provider Login

ICD-10 2016 Updates:

CMS is issuing an updated list of additional ICD-10 codes that will become effective October 1, 2016. This document provides instructions to submitters on how to test the new ICD-10 claims through EDI. It is not intended to provide instructions for submitting a claim through EDI, which can be found in the document, EDI Online Submission Instructions.

  • The submitter must ensure that the ISA15 data element of the Interchange Control Header Segment of the submitted file is set to 'T' (for test files).
  • The submitter must ensure that their own processes correctly detect the presence of a 'T' in the ISA15 data element of the Interchange Control Header Segment of the resulting outbound X12 files (for example, 277CA and 835), so that they do not inadvertently pull test outbound files into their production processes.

All claim types can be tested in the ICD-10 Testing Environment, including Professional and Institutional Claims.

Production Site for Testing:

For providers wishing to test claim submission and processing using ICD-10 codes that will be effective 10/01/2016, the "Test" Effective Start Dates will be July 1, 2016. Providers can bill test claims with the new ICD-10 codes with dates of service on or after 07/01/2016.

New ICD-10 Diagnosis Codes:

The Centers for Disease Control and Prevention released roughly 1,900 diagnosis codes that will be added to the ICD-10 coding system for health care claims.
In addition some 3,651 new ICD-10 PCS inpatient procedure codes will be added. ICD-10 PCS. The large number of new codes is due to a partial freeze on updates to the ICD-10-CM and ICD-10 PCS codes prior to implementation of ICD-10 on
Oct. 1, 2015. New ICD-10 diagnosis and procedure codes need to be implemented by Oct. 1, 2016.

Providers will want to ensure that their Claims systems, EHR systems and clearinghouses are prepared and up to speed with these new changes then determine impacts the new codes will have on clinical documentation, billing and medical policies.

Future communication and updates will be sent once CMS releases new code sets.

The New Mexico Web Portal extends the business capabilities of Medicaid program providers by offering user-friendly tools and resources electronically. Registered users may Log In to access the following interactive features of the portal:

  • Claim Status Inquiry
  • Prior Authorization Inquiry
  • Eligibility Inquiry
  • Payment History Inquiry
  • Reports and Data Files

Currently enrolled providers can register for portal access using Web Registration. New providers seeking to join the program can download a Provider Enrollment Packet for step-by-step instructions.

The left navigation menu contains hyperlinks for the interactive features that you may access while logged in. Hyperlinks located in the top and bottom navigation menus allow you to access additional useful information.

For more information about the web portal or New Mexico Medicaid program, turn to the FAQ, What's New, New Mexico Medicaid E-News, or Search functionality.