MEDICAID BILLING FOR NONINDEPENDENT PRACTITIONERS John Baldonado LADAC

MEDICAID BILLING FOR NON-INDEPENDENT PRACTITIONERS John Baldonado, LADAC – Owner Canyon Light Inc. Rhonda Baldonado – Co-Owner Canyon Light Inc.

BUSINESS TYPES • The types of corporations that have their details recorded in the New • Mexico business corporation registry are as follows: Corporations. Limited Liability Company. Limited Partnerships. Limited Liability Partnerships.

THERE ARE MANY VARIETIES OF BUSINESS OWNERSHIP: • Sole proprietorship • You are a sole proprietor if you own all the assets of a business. You also assume liability for all debts of the business. You have no partners, and you are not incorporated. • Partnership • You are a partnership if two or more persons or entities engage in a contract to share in the profits from property, credit, skill or industry.

• Corporation • You are a corporation if you are: organized under the business corporations act of the state of your organization; a joint stock company; a real estate trust organized and operated under the Real Estate Trust Act; a financial corporation, or a bank. • For information on corporate income and franchise taxes, download FYI-350: Corporate Income Tax and Corporate Franchise Tax.

limited liability company - You are a limited liability company when you are organized under the limited liability company act of your state of organization. • nonprofit corporation and organization - You are a nonprofit corporation if you are organized under the nonprofit corporation act of the state where your corporation is domiciled. Certain nonprofit organizations are also tax exempt. You are a tax-exempt organization if the federal government has granted you tax-exempt status under Section 501(c) of the Internal Revenue Code. Business income unrelated to your recognized tax-exempt status is taxable federally and in New Mexico. To see information on tax-exempt organizations, download FYI-103: Information for Non-Profit Organizations. For additional information, see also Brochure #4 501(c)(3) Nonprofit Groups & New Mexico’s Gross Receipts Tax

If you are considering starting a business in New Mexico, you must decide how to organize your business. The decision involves many different factors, including questions of legal liability, tax considerations, and operational factors. It is a good idea to consult with professionals in making this decision. Many of the registration and licensing requirements imposed by state and local governments are determined by the type of entity that you select. For more information, see starting a New Mexico business.

OBTAIN TAX ID NUMBERS • 1) Select the FEDERAL ID • 2) All owners of New Mexico businesses registered as a NUMBER HOME link to Partnership, Limited Liability obtain a Federal Employer Company or CORPORATION Identification Number (EIN) must obtain a New Mexico tax identification number; CRS Tax ID number. Select sometimes referred to as the GET STATE CRS FEIN. NUMBER link to obtain a New Mexico Combined Reporting System (CRS) number.

GETTING NEW MEXICO CRS NUMBER • IMPORTANT: Before you apply for a State CRS number, make sure you have the following: • • *Your Federal Tax ID number (EIN); • *Your business registration number from the Secretary of State; and

NPI NUMBER NATIONAL PROVIDER IDENTIFIER • A National Provider Identifier is a unique 10 -digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services. The NPI has replaced the unique physician identification number as the required identifier for Medicare services, and is used by other payers, including commercial healthcare insurers. The transition to the NPI was mandated as part of the Administrative Simplifications portion of the Health Insurance Portability and Accountability Act of 1996. • An NPI Identifier is needed for all insurance claims.

CAQH COUNCIL FOR AFFORDABLE QUALITY HEALTHCARE • About CAQH • CAQH, a non-profit alliance, is the leader in creating shared initiatives to streamline the business of healthcare. Through collaboration and innovation, CAQH accelerates the transformation of business processes, delivering value to providers, patients and health plans.

COB Smart® quickly and accurately directs coordination of benefits processes. Enroll. Hub® reduces costly paper checks with enrollment for electronic payments and electronic remittance advice. CAQH Pro. View® eases the burden of provider data collection, maintenance and distribution. Direct. Assure® increases the accuracy of health plan provider directories. Veri. Fide. TM streamlines credentialing by consolidating and standardizing primary source verification. Sanctions. Track® delivers comprehensive, multi-state information on healthcare provider licensure disciplinary actions. CAQH CORE® maximizes business efficiency and savings by developing and implementing national operating rules. CAQH Index® benchmarks progress and helps optimize operations by tracking industry adoption of electronic administrative transactions.

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MEDICAID CREDENTIALING

MEDICAID BILLING MCO’S

Agency Type Blue Cross Blue Shield Original Term January 19, 2018 thru December 31, 2022 October 30, 2018 thru Blue Cross Blue Shield Amended and Restated December 31, 2022 Amendment #1 Presbyterian Health January 19, 2018 thru Original Care December 31, 2022 October 30, 2018 thru Presbyterian Health Amended and Restated December 31, 2022 Care Amendment #1 Western Sky January 19, 2018 thru Original Community Care December 31, 2022 October 30, 2018 thru Western Sky Amended and Restated Community December 31, 2022 Care Amendment #1

NEW MEXICO MEDICAID SUPPLEMENT 1904

(1)a licensed alcohol and drug abuse counselor (LADAC) licensed by RLD's Counseling and Therapy Practice Board or a certified alcohol and drug abuse counselor (CADC) certified by the New Mexico Credentialing Board for Behavioral Health Professionals (CBBHP). Independent practice is for alcohol and drug abuse diagnoses only. The LADAC or CADC may provide therapeutic services that may include treatment of clients with co-occurring disorders or dual diagnoses in an integrated behavioral health setting in which an interdisciplinary team has developed an interdisciplinary treatment plan that is co-authorized by an independently licensed counselor or therapist. The treatment of a mental health disorder must be supervised by an independently licensed counselor or therapist; or

(1)Non-licensed practitioners must be one of the following: (a)a master's level behavioral health intern; (b)a psychology intern; (c)a pre-licensure psychology post doctorate student; (d)a certified peer support worker; (e)a certified family peer support worker; or (f)a provisional or temporarily licensed masters level behavioral health professional.

INTERDISCIPLINARY TEAMING