Denials and ERA
Work denials by pattern, not one claim at a time.
Rejection versus denial triage, category-based follow-up, ERA review and posting, and corrections that close the loop before timely filing runs out.
A denial log that is only a list of claims produces rework. A denial log organized by category produces fixes, because it shows where the problem actually started.
We group denials, trace each category to the upstream step that created it, and build the follow-up into a routine your staff can maintain.
Triage: rejection or denial
A clearinghouse rejection means the claim never reached the payer — usually formatting, identifiers, or enrollment inside your own submission path. A payer denial means the claim was adjudicated against plan rules. They are worked in different places by different people.
Categories we work
Common behavioral-health denial and rejection patterns, grouped so that fixes apply to whole cohorts of claims.
- A7 and related acknowledgement rejections
- CO-97 bundling and included-service denials
- OA-18 duplicate claim denials
- Authorization missing, expired, or insufficient units
- Eligibility inactive or different plan on the date of service
- Provider identifier, taxonomy, and affiliation issues
- Roster and participation denials
- Documentation and medical-necessity denials
- Timely filing
ERA review, posting, and reconciliation
Remittances are the feedback loop. Posting them promptly and reconciling in both directions — services to claims, claims to remittances — surfaces silent revenue loss that denial reports alone will not show.
- ERA enrollment so remittances return automatically
- Posting accuracy and adjustment review
- Partial payment and takeback tracking
- Correction, resubmission, and appeal follow-through
- Aging review against timely filing windows
Denial code meanings and appeal rights are payer-specific. Confirm each code and process with the issuing payer. No workflow guarantees payment.
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)
- N.M. Admin. Code § 8.321.2.26 — SUD Intensive Outpatient Program
- N.M. Admin. Code § 8.321.2.27 — Mental-Health Intensive Outpatient Program
- New Mexico HCA — Provider Enrollment (PED)
- ASAM Criteria — About the ASAM Criteria
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
Next step
Start with the checklist, then talk through your workflow.
The checklist covers common pre-submission review points that can help identify avoidable claim problems. A workflow conversation covers the rest.
Get the New Mexico Behavioral-Health Billing Checklist
A practical pre-submission review for Medicaid, IOP, CCSS, and behavioral-health claims. No patient information required.