PROVIDERS
The Health Care Authority’s mission is: We ensure that New Mexicans attain their highest level of health by providing whole-person, cost-effective, accessible, and high-quality health care and safety-net services.
Emergency Medical Services for Non-Citizens (EMSNC) Claims Process
EMSNC provides coverage of emergency services for certain non-citizens who are undocumented or who do not meet the qualifying immigration criteria, and meet all eligibility criteria for an existing Medicaid category except for their non-citizen status (Category of Eligibility 085).
EMSNC claims can be submitted via the New Mexico Medicaid Web Portal or mailed to:
Conduent
P.O. Box 26500
Albuquerque, NM 87125-6500
Note:Paper claims must be original claim forms; copies will not be accepted and will be returned.
When submitting EMSNC claims, please include the following documentation:
- MAD-310 or MAD-778 form (Notification of Approval of Application for Emergency Medical Services for Non-Citizens) or NOCA (Notice of Case
Action) from local Income Support Division office. - Pertinent medical records to determine the emergency medical condition.
Inpatient Facility:
- MAD 310, MAD 778 or NOCA form (Dates on MAD 310, MAD 778 or NOCA form must match the dates of service on the claim)
- Admit History and Physical
- Emergency Department Records
- Discharge summary
- Any pertinent diagnostic imaging and/or lab results (if not included in H&P or Discharge Summary)
- Operative Notes (ONLY if Surgery was done)
Outpatient services:
- MAD 310, MAD 778 or NOCA form (Dates on MAD 310, MAD 778 or NOCA form must match the dates of service on the claim)
- History and Physical
- Operative Notes (ONLY if Surgery was done)
- Emergency Department Records
Note:The submitted claim documentation must match the patient’s name that is on the MAD 310, MAD 778 or NOCA form.
Physician, Lab and Transportation:
It is not necessary for providers to attach a MAD 310, MAD 778 or NOCA to process EMSNC claims for types Physician (P), Lab (L) and Transportation (T) as claim types will not pay without an approved Inpatient (I) or Outpatient (O) claim.
- A cover letter with your contact information is recommended so we can contact you if necessary.
Please allow approximately 4 weeks for claims processing. Once processed, a claim status can be viewed on the New Mexico Medicaid Web Portal and on your Remittance Advice.
For questions regarding claim status, please call the Consolidated Customer Service Center (CCSC) at 1-800-299-7304 or via email at NM.Providers@state.nm.us.
For questions regarding EMSNC medical reviews please contact Comagine Health (previously Qualis Health) TPA/UR toll-free Customer Service Line at 1-866-962-2180.
Reconsiderations may only be requested via fax or mail within 30 calendar days from the date of notice.
Reconsideration request may be sent to Comagine Health (previously Qualis Health) TPA via fax (888-562-2755) or mailed to:
Comagine Health (previously Qualis Health) TPA
Attn: EMSNC Reconsideration Requests
PO Box 20910
Albuquerque, NM 87154-0910
For more information please refer to the New Mexico Administrative Code (NMAC) below:
NMAC 8.325.10 – Specialty Services for Emergency Medical Services for Non-Citizens
https://www.hsd.state.nm.us/providers/rules-nm-administrative-code/