Bill > HB136

This bill requires the Health Care Authority (HCA) to establish a centralized credentialing application process for individual healthcare providers, meaning providers will only need to submit one application to the HCA, and Medicaid managed care contractors will use that application to make their own credentialing decisions. Credentialing refers to the process of verifying a provider's qualifications to ensure they can provide healthcare services. Under this new process, Medicaid managed care contractors must assess and decide on an application within 30 calendar days, with a possible 15-day extension if additional review is needed due to specific circumstances like sanctions or investigations. They must also notify applicants of any missing information within 10 days and, importantly, load all approved provider information into their payment systems within the same 30 or 45-day timeframe to ensure timely reimbursement. Furthermore, providers will not need to undergo subsequent credentialing more than once every three years after their initial approval, and the HCA will be responsible for creating rules to implement these changes, though contractors are still permitted to deny credentialing to providers who don't meet their specific plan requirements.

https://www.nmlegis.gov/Legislation/Legislation?chamber=H&legtype=B&legno=136&year=26