APPLY FOR BENEFITS

Kevin S. Settlement
Keep Your Benefits NM
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Grievances and Appeals

Use this email to submit questions, concerns, or grievances to the Human Services Department’s Medical Assistance Division (HCA/MAD): MADInfo.HCA@hca.nm.gov

Or, use the links below to submit grievances directly to the Medicaid Managed Care Organizations (MCO).

Members

See the BCBS member website: Understand BCBSNM Appeals and Grievances | Blue Cross and Blue Shield of New Mexico 

Providers

First check the Claim Status Tool  using either the member ID or claim number. If the claim qualifies, the appropriate review option will be displayed.

If no electronic option is available, please contact Provider Customer Service or submit a written claim review with supporting documentation by contacting

Blue Cross Blue Shield Turquoise Care Grievances.

Phone: 1-866-689-1523

Fax: 1-888-240-3004

Mailing address:

Turquoise Care Grievances

P.O. Box 660717

Dallas, TX 75266

Email address: GPDAG@bcbsnm.com

 

  • Presbyterian Health Plan:

Members

Members can obtain information about and submit grievances and appeals at PHP Member Forms and Documents. Select Turquoise Care in the Plan Name field and choose Online Form to Submit a Grievance or Appeal. Here is the direct link to the submission form: Member Grievance and Appeal Submission Form

Providers

Providers can obtain information about and submit grievances and appeals at Provider Appeals and Grievances web page and select Provider Appeals and Grievances Form.

Member and Provider Processes

 

Contact

The online submission forms are the primary mechanisms for submitting grievances and appeals. Additional contact information is available on the corresponding member and provider webpages.

Contact Turquoise Care PCSC at 505-923-5200.

 

  • Molina

Members

Members may file an appeal or grievance by contacting the Molina Member Services Department: (844) 862-4543, Hearing Impaired TTY/NM Relay: 1-800-659-8331 or 711

Written appeal/grievance requests may be sent to the Appeal & Grievance Department:

Fax Number: (505) 342-0583

Mailing address: Molina Healthcare of New Mexico, Inc. Attn: Appeals & Grievances Department PO Box 182273 Chattanooga, TN 37422

Email Address: MNM.Medicaid.MemberAppealsandGrievances@molinahealthcare.com

 

Providers

Provider grievances may be submitted by telephone, by fax, via email or in writing. Providers may generate a grievance by calling the Molina Provider Contact Center during regular business hours at (855) 322-4078.

Claim Disputes/Reconsiderations/Appeals may be submitted via fax, secure email, or mail.

Claims Disputes/Reconsideration requested via the PRR may be sent to the following address: Molina Healthcare of New Mexico, Inc. Attention: Claims Disputes/Adjustments PO Box 182273 Chattanooga, TN 37422

Fax: (855) 378-3642

Written Provider Appeals must be submitted via the Availity Essentials portal or faxed toll-free to (855) 378-3643.

 

  • United Healthcare

Members

  • Written grievances may be sent to:

UnitedHealthcare Community Plan Turquoise Care

Appeals and Grievances

P.O. Box 31364

Salt Lake City, UT 84131-0364

 

Providers

  • Providers may submit a grievance or appeal over the phone to 888-702-2202.
  • Written grievances may be sent to:

UnitedHealthcare Community Plan Turquoise Care

Appeals and Grievances

P.O. Box 31364

Salt Lake City, UT 84131-0364