Navigating Behavioral Health Agency Credentialing and RCM Best Practices in New Mexico

In New Mexico, Behavioral Health (BH) agencies play a vital role in delivering specialized treatment and training to providers seeking independent licensure. These agencies provide an array of services, from comprehensive community support to opioid treatment programs. To effectively manage the complexities of Revenue Cycle Management (RCM) and credentialing, healthcare practices must stay compliant with the specific state requirements for BH agencies.

At Svast Healthcare Technologies, we assist practices in navigating these requirements efficiently, ensuring smooth credentialing processes and optimal RCM practices. Here’s a breakdown of what healthcare practices need to know.

Understanding the Structure of Behavioral Health Agencies

Behavioral Health agencies in New Mexico typically support providers through their licensure journey. There are several key BH licenses and provider types, such as:

• LMHC (Licensed Mental Health Counselor – Non-Independent)
• LCSW (Licensed Clinical Social Worker – Independent)
• PMHNP (Psychiatric Mental Health Nurse Practitioner – Independent)
• MD (Medical Doctor – Psychiatric)

These agencies often operate to help non-independent providers gain necessary supervision hours to qualify for independent practice. However, establishing an agency requires paperwork, certifications, and accreditation processes through New Mexico’s Behavioral Health Services Division (BHSD), which can take anywhere from four months to a year.

Types of Behavioral Health Agencies

BH agencies in New Mexico can take on various forms, such as:

• CMHC (Community Mental Health Center)
• FQHC (Federally Qualified Health Center)
• CSA (Core Services Agency)
• OTP (Opioid Treatment Program)

Each agency type has specific requirements for certification and maintenance, and the services they offer may vary widely.

Revenue Cycle Management (RCM) for Behavioral Health Agencies

Effective RCM for Behavioral Health agencies requires detailed knowledge of Medicaid enrollment, payer contracts, and the services covered by different insurance plans. Not all services provided by these agencies are covered under Medicare or Medicaid. Credentialing plays a crucial role in ensuring that services are recognized and reimbursed by payers. Medicaid enrollment for agencies in New Mexico is mandatory, but certain commercial plans may require additional credentialing steps and contract negotiations.

Best Practices in Credentialing

Proper credentialing is key to the financial success of Behavioral Health agencies. Here are the do’s and don’ts when managing credentialing for these agencies:

Do’s:

• License Renewal Tracking: Regularly monitor license and certification renewal dates. Submit renewed licenses to NM Medicaid before they expire to avoid enrollment suspension.
• Portal Usage: NM Medicaid now requires all credentialing activities to be completed via their online portal, as paper applications are no longer accepted.
• Provider Roster Updates: Ensure payer rosters are regularly updated with accurate provider data, including active and terminated providers.
• Revalidation Tracking: Keep track of recredentialing and revalidation dates with payers to avoid credentialing terminations.
• Medicaid/Medicare Site Visits: Be proactive in informing clients about potential site visits from Medicare and Medicaid for new practice enrollments.

Don’ts:

• Incomplete Applications: Avoid submitting incomplete credentialing applications, which can delay the process significantly.
• Premature Revalidation Applications: For NM Medicaid, do not submit revalidation applications more than 2-3 months prior to the revalidation date, as they will not be processed early.
• Retroactive Dates: Do not promise clients retroactive effective dates unless confirmed by the payer.
• Premature Medicare Applications: Medicare applications submitted more than two months before the intended effective date will not be accepted.
• Non-Independent Provider Enrollments: Avoid submitting Medicare applications for non-independent providers who do not meet the necessary supervision and certification requirements.

Conclusion

Managing credentialing and RCM for Behavioral Health agencies in New Mexico involves numerous steps, from ensuring compliance with state regulations to maintaining payer relationships. At Svast Healthcare Technologies, we specialize in guiding healthcare practices through these processes, ensuring operational efficiency and optimized revenue cycles.