Free checklist
TherapyNotes Billing Setup Checklist: New Mexico Behavioral Health
This checklist offers practical, operational guidance for New Mexico behavioral health providers setting up or refining their billing processes within TherapyNotes. It focuses on critical steps for managing claims effectively, aligning with New Mexico Medicaid and MCO requirements. This is operational guidance, not legal, financial, or clinical advice.
Who it's for: New Mexico behavioral health providers, billing staff, and practice administrators utilizing TherapyNotes for claim submission and revenue cycle management.
Initial TherapyNotes Configuration & Payer Setup
- Confirm TherapyNotes account details are accurate for your practice.
- Add all relevant MCO and Medicaid payers (e.g., Turquoise Care, Molina, Presbyterian, UnitedHealthcare Community Plan) with correct payer IDs.
- Ensure NPI, EIN, and tax ID information is entered correctly for the practice and all rendering providers.
- Verify your MCO credentialing status is active and linked within TherapyNotes for each payer.
- Set up rendering providers with individual NPIs and MCO enrollment statuses.
- Configure service codes (CPT/HCPCS) with appropriate fees, linking them to your service types.
- Establish common diagnosis codes (ICD-10) for quick access.
- Review and update any practice-specific custom fields needed for claims.
Client and Insurance Information Management
- Accurately input client demographic information, including date of birth and address.
- Enter primary and secondary insurance details, including plan name and member ID.
- Confirm insurance effective dates and termination dates are current.
- Verify all required fields for New Mexico Medicaid or MCO clients are populated.
- Establish client authorization tracking for services requiring pre-approval.
- Implement a process for regular insurance eligibility verification.
Service Documentation & Claim Generation Workflows
- Ensure clinical notes are completed and signed before claim generation.
- Verify CPT/HCPCS codes, modifiers, and units align with documented services.
- Confirm diagnosis codes support the billed services.
- Review date of service accuracy for each entry.
- Establish a routine for generating claims (e.g., daily, weekly).
- Utilize TherapyNotes' built-in claim scrubbing features to identify common errors.
Claim Submission & Follow-Up
- Submit claims electronically through TherapyNotes' integrated clearinghouse.
- Regularly check claim submission reports for rejected claims.
- Address clearinghouse rejections promptly by correcting and resubmitting.
- Track claim status within TherapyNotes or your clearinghouse portal.
- Implement a workflow for following up on unpaid or denied claims after appropriate waiting periods.
- Review ERA/EOBs within TherapyNotes to reconcile payments and identify denials.
Denial Management & Appeals
- Categorize denials by reason code to identify trends.
- Research denial reasons using payer policies (e.g., New Mexico Medicaid Behavioral Health Policy and Billing Manual).
- Formulate appeals based on payer guidelines and clinical documentation.
- Submit corrected claims or appeals in a timely manner.
- Track the status of appealed claims through resolution.
- Adjust future billing practices based on denial patterns to reduce reoccurrences.
Practical tips
- Regularly review your TherapyNotes settings and payer rules, as requirements can change.
- Utilize TherapyNotes' reporting features to monitor claim status and identify potential issues early.
- Maintain clear internal communication between clinical and billing staff to ensure complete and accurate documentation for claims.
Sources and verification
- New Mexico HCA — Turquoise Care
- New Mexico Behavioral Health Policy and Billing Manual — Introduction, version dated 4.1.25
- New Mexico Behavioral Health Service Standards — June 1, 2025
- New Mexico HCA — Program Rules (NM Administrative Code)
- New Mexico HCA — Provider Enrollment (PED)
- New Mexico Medicaid Behavioral Health Policy and Billing Manual — Essential for understanding state-specific billing requirements and coverage for behavioral health services. Always refer to the most current version.
- Applicable MCO Provider Manuals (e.g., Molina, Presbyterian, UnitedHealthcare Community Plan) — Each managed care organization has specific billing guidelines, authorization requirements, and claim submission rules that must be followed. Providers should consult the relevant manual for each MCO.
- CMS (Centers for Medicare & Medicaid Services) — Provides guidance on CPT/HCPCS codes, modifiers, and general billing principles that often inform state Medicaid and MCO policies.
Requirements, manuals, and payer policies may change; confirm the current version before relying on any source. Listed sources do not endorse New Mexico Billing.
Information on this website is educational and operational in nature. New Mexico rules, Medicaid manuals, payer policies, authorization requirements, and ASAM guidance may change. This website is not legal, clinical, coding, compliance, or payer-contracting advice.
Last reviewed: September 2026
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