LOD 103 Medicaid Provider Rate Increase
Subject: Medicaid Provider Rate Increase
Dear Valued Provider,
Thank you for the care that you provide for Western Sky Community Care members and the people of New Mexico.
Medicaid is a key strategy in transforming healthcare in New Mexico and adequate payments rates are critical to support the providers throughout our state. Last Spring, HB2 appropriations became law and effective July 1, 2023, significantly increased Medicaid payments to healthcare providers. Western Sky Community Care is committed to partnering with New Mexico providers and making sure the increased payments are passed directly to you.
We received final direction about the increased payments from HSD in a Letter of Direction (LOD) on September 13, 2023 and we are committed to the requirement to implement sixty (60) days from our receipt of the LOD. We have prioritized system configurations needed to pay the increased rates and will automatically reprocess claims with dates of service retro back to July 1, 2023.
You will not need to do anything. Western Sky Community Care providers will not need to submit corrected claims to receive the updated rates. You will first start to see increased payments on your Explanation of Provider Payments. Then you will start to see retro-active adjustments to previous payments for dates of service after July 1st, on your Explanation of Provider Payments. Western Sky Community Care is committed to passing along all increased payments and not adding administrative burden to you as we will automatically pull and reprocess impacted claims.
For your information, the new rates can be found in the attached LOD #103 Attachment 1 – Final Rate Table HCPCS Description. They can also be found at www.hsd.state.nm.us/lookingforinformation/centennial-care-letters-of-direction/
We are here to support you and answer your questions. Please contact your Western Sky Community Care Provider Engagement Specialist with any questions. The Provider Engagement Specialists’ assignments and contact information can be found at
www.westernskycommunitycare.com or call our general number at 1.844.738.5019
Thank you for your continued partnership in serving some of the most vulnerable New Mexicans.
Plan President & CEO