School Based Healthcare Center's (SBHC) are a hub for Medicaid outreach and enrollment. Everyday SBHCs perform Medicaid "outreach"-- reaching out the community to let them know that families can sign up for Medicaid at the SBHC, and "enrollment"-- actually processing the PE/MOSAA applications and enrolling families.
These services are vital to families. This page is designed to help support your outreach and enrollment work.
EPSDT/Comprehensive Wellness Exam Guidance
NMHSD has provided guidance for SBHCs regarding the reimbursement regulations and periodicity recommendations for EPSDTs that will be helpful to all SBHCs. Please visit www.nmasbhc.org/news.html to see the update. There are three tools under November 2015 that can be of help in the delivery and reimbursement for EPSDTs.
Xerox Support: ICD-10 and NPI Numbers
Xerox is an HSD-contracted entity that provides a number of services and data resources related to Medicaid billing. Two newly advertised tools may be of special interest to SBHCs:
Xerox Web Portal NPI Search Feature: clinics seeking the correct NPI Number for their clinic or provider, may search the portal by name or NPI to determine if a provider is actively enrolled in fee-for-service (FFS) and/or through a managed care organization. No secure sign-in is required for this new service. This feature is located on the left navigation of the Provider Login and Provider Information pages. Visit: https://nmmedicaid.acs-inc.com/static/ProviderInformation.htm to use the service.
As of 10/1/15, Xerox also has new Provider ICD-10 Support Contact Information to accommodate Provider related ICD-10 inquiries. Business hours are 8 a.m. - 5 p.m., Monday - Friday and Thursday 8 a.m. - 4 p.m. General ICD-10 Questions and Issues: Xerox PR Call Center 1-800-299-7304 Option 7 or locally at 505-246-0710.
Sample Participant Provider Agreement for MAD
MAD Agreement Example
Additional Requirements for Provider Participation and MAD Applicant Instructions
If you have any questions regarding entities qualified to participate as PEDs, the PED certification process or for more information on training sessions being scheduled for future months, please e-mail New Mexico Human Services Department, Medical Assistance Division Presumptive Eligibility Program Staff at: HSD.PEDeterminers@state.nm.us
Claims and Billing 101 Presentation
This is a great tool for understanding School-Based Health Claims and Billing that came out of the 2015 Head to Toe Conference!
Outreach Resources for SBHCs
New MexiKids and New MexiTeens are no cost or low cost health care coverage programs for children and young adults under 19 years of age. The programs are some of the many that are available to New Mexico's families from the Human Services Department's Insure New Mexico! Solutions. New MexiKids and New MexiTeens are part of the New Mexico Medicaid program that is also known as Centennial Care. CLICK HERE FOR MORE INFO
Effective outreach strategies for SBHCs (PDF): This document summarizes effective outreach strategies that have been implemented by SBHCs in NM.
Regulations for New Mexico's Medicaid programs are promulgated by the Human Services Department, Medical Assistance Division. The Department's Income Support Division offices make eligibility determinations for Medicaid, except for those categories administered by the Children, Youth and Families Department, the Social Security Administration, and the Premium Assistance programs.