New Mexico Medicaid adds streamlined process to validate provider credentials

New Medicaid providers can now use a single platform for credentialing across all four managed care organizations.

Source: New Mexico Health Care Authority

SANTA FE — New Mexico Medicaid providers can now credential with all four of the state’s managed care organizations through a single platform, eliminating duplicative applications and accelerating how quickly providers can begin serving Medicaid members. 

Blue Cross and Blue Shield of New Mexico, Molina Healthcare, Presbyterian Health Plan and UnitedHealthcare now use the CertifyOS platform to streamline and accelerate provider credentialing. 

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“We heard providers loud and clear that credentialing with each health plan was burdensome and time consuming,” said Alanna Dancis, Acting Medicaid Director. “Now all four health plans use CertifyOS, a single platform to validate the credentials every provider needs in order to contract with each managed care organization and serve New Mexicans.” 

The state has simplified provider credentialing through a new statewide platform used by all four Turquoise Care managed care organizations. The change reduces paperwork, speeds up contracting and helps providers get connected to Medicaid patients faster.  

“We are excited to help New Mexico remove the inefficiencies that slow provider onboarding and strain operations,” said Anshul Rathi, CertifyOS CEO. “By unifying credentialing and recredentialing, standardizing verification, and eliminating duplicative workflows across health plans, we strive to reduce administrative burden, accelerate time-to-network, and improve member access.” 

The streamlined process is expected to: 

• Reduce administrative burden for providers. 
• Accelerate time to managed care contracting. 
• Support faster access to care for Medicaid members.  

New Mexico Medicaid continues to prioritize provider enrollment experience and subsequently increase access to care for Medicaid members. By modernizing credentialing infrastructure, the state aims to strengthen its provider network and ensure timely access to high-quality services for Medicaid members statewide. 

Providers interested in enrolling as a Medicaid provider can find more information at YES.NM.Gov. Create a provider account and navigate to the Learning Management System for recorded and live training. Learn more at the Medicaid Provider Enrollment web page.