NM HB136

Health Care Authority must establish a centralized credentialing application process for individual Medicaid providers by January 1, 2027, allowing providers to submit only one application that all managed care contractors use for credentialing decisions

Medicaid managed care contractors must assess and verify provider qualifications within 30 calendar days of receiving a complete application, with a possible 15-day extension for complex circumstances such as felony investigations or licensing board sanctions

Contractors must send written notification via certified mail within 10 days of receiving an application requesting any missing information, including a designated point of contact for the applicant

Approved provider information must be loaded into the contractor's payment system and provider directory within the 30-45 day credentialing period

Re-credentialing of providers cannot be required more than once every three years after initial credentialing