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News update

Dec 02, 2025

New Mexico Medicaid: Providers to Receive Reimbursement for Gross Receipts Tax

Starting Jan 01, 2026, New Mexico’s Senate Bill 249 will require managed care organizations (MCOs) to repay health care providers for the gross receipts tax (GRT) they owe on Medicaid services delivered to that MCOs’ members. This reimbursement rule does not apply to non-profit providers or to claims involving prescription drugs, durable medical equipment, or specific medical codes that are already exempt from tax.

What this means for providers

UnitedHealthcare’s remittance advice notices will include the gross receipts tax (GRT) and the service payment as two separate, clearly itemized lines.

Providers can reach support anytime through 24/7 chat in the UnitedHealthcare Provider Portal.

Services

Credentialing

Credentialing is the rigorous process of verifying a healthcare provider’s qualifications, including their education, training, licenses, and clinical experience. This service ensures that practitioners meet the high standards required by insurance networks and hospitals to provide care and receive reimbursement.

Billing & Collection

Billing and Collection service involves confirming a patient’s insurance coverage, active status, and specific benefits before their appointment. By identifying co-pays, deductibles, and required prior authorizations upfront, staff can prevent claim denials and help patients understand their financial responsibilities.

Eligibility Verification

Eligibility verification is the process of verifying a patient’s health insurance coverage and benefits to determine what services are covered and the level of coverage available. This process is essential for healthcare providers to ensure that they receive proper reimbursement for services rendered and that patients are not left with unexpected medical bills.

Revenue Cycle Management

RCM is the financial process that manages the entire lifecycle of a patient’s account, from the initial appointment scheduling to the final balance payment. It integrates eligibility, coding, billing, and collections into a single, cohesive workflow aimed at maximizing a practice's profitability.

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It has been a wonderful experience working with Sean. He made the credentialing process a breeze with his knowledge and communication skills. I highly recommend Capline.

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Rylan is wonderfull representetive, and very quick to complete all his task. We recomend his services, great company and great costumer service. We give him a 5 star.

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