Behavioral Health

Non-Participating Behavioral Health Providers

Notice to Non-Participating Behavioral Health Providers Submitting Claims to United Healthcare Community Plan of New Mexico for the New Mexico Centennial Care Behavioral Health Program

The minimum claims submission requirements for United Healthcare Community Plan of New Mexico are listed below. Claims submission from a non-participating provider (to include out-of-state providers) must meet these requirements to be eligible for payment. New Mexico Centennial Care’s Behavioral Health program has strict rules on the types of providers allowed to render services to Managed Medicaid consumers. (See lists below).

In accordance with the New Mexico Human Services Department (HSD), reimbursement for non-participating provider claims will be at 95% of the State of New Mexico rates. Behavioral health reimbursement rates can be found at the New Mexico Human Services Department website. United Healthcare Community Plan of New Mexico will only reimburse for procedure codes and services that are a part of the covered benefit.

Approved New Mexico Centennial Care Provider Types

Independent Practitioners

  • Individuals licensed as psychiatrists  
  • Individuals Licensed Clinical Nurse Specialists or Certified Nurse Practitioners
  • Licensed Independent Social Workers (LISW)
  • Licensed Professional Clinical Mental Health Counselor (LPCC)
  • Licensed Marriage and Family Therapists (LMFT)
  • Psychologists (Ph.D., Psy.D. or Ed.D.)

Agencies (that bill for non-independent practitioner services)

  • Children, Youth and Families departments (CYFD)
  • Community Mental Health Centers (CMHC)
  • Core Service Agencies (CSA)
  • Federally Qualified Health Centers (FQHC)
  • Hospitals and their Outpatient Facilities
  • Indian Health Service (IHS) Hospitals and Clinics
  • PL-638 providers

Facilities/hospital-based providers that offer inpatient or higher levels of care

  • Community Mental Health Centers (CMHC)
  • Core Service Agencies (CSA)Inpatient Facilities
  • Federally Qualified Health Centers (FQHC)
  • Group Homes
  • Indian Health Services / PL - 638 Providers
  • Residential Treatment Centers (RTC)
  • Rural Health Clinics (RHC)
  • School Based Health Clinics (SBHC)
  • Substance Use Disorder Agencies (SUD)
  • Treatment Foster Care Providers

Services Requiring Prior Authorization

  • Accredited Residential Treatment Center (ARTC) Services
  • Adaptive Skills Building (ASB)
  • ECT (University of NM only)
  • Group Home (GH)
  • Inpatient Psychiatric Care in a Free Standing Psychiatric Hospital & Hospital Services (Inpatient Hospitalization in Psychiatric Units)
  • Non-Accredited Residential Treatment Center (RTC) Services
  • Treatment Foster Care I (TFCI)
  • Treatment Foster Care II (TFCII)

United Healthcare Community plan of New Mexico reserves the right to recoup payments from non-participating behavioral health providers that do not meet the minimum requirements as referenced above.  To become a participating provider of behavioral health services with United Healthcare Community Plan of New Mexico.