Shoreline Healthcare Technologies is a proud Maine-based company that offers end to end revenue cycle management services to physicians and Medical billing companies  in New Mexico. Our goal is to help them manage their business in a way where they can focus on patient care and operations, not paperwork! By providing great services at reduced costs, we have been able to keep our customers since our inception in 2015. Explore our case studies to see how we’ve helped practices overcome complex billing challenges and improve cash flow.

As a medical billing outsourcing company, we have helped our clients grow their business by providing them with the resources they need to succeed while maintaining a competitive edge in today’s industry. We offer timesaving, cost-effective revenue cycle management services to your New Mexico-based practice. Ready to outsource your billing needs? We’ll guide you through your receivable account to make sure that your claims are paid.

Best In the Industry

Shoreline Healthcare Technologies in New Mexico exceeds customer expectations and we are proud of our history, but more importantly we are focused on the future. We have grown in recent years by continuing to invest in technology and people while maintaining a commitment to excellent service and innovation. We have the best customer service and one of the highest success rates for reimbursement, so you know your money will be going where it belongs - back into your pocket.

New Mexico Billing Challenges we solve

Eliminating Managed Care vs Fee-For-Service confusion

Providers in New Mexico must deal with both the Managed care and Fee-For-Service (FFS) with different rules, timelines, payer IDs, and authorization pathways. This split can create avoidable errors like sending claims to the wrong payer/clearinghouse route, applying the wrong prior auth rules, or using the wrong payer ID/EDI companion guidance. At Shoreline Healthcare Technologies we solve this problem by building payer-specific billing pathways for each NM Medicaid MCO and FFS scenario. We use coverage-type logic at every claim creation to route the claims correctly the very first time. And maintains a separate rule sets for MCO encounters vs FFS claims and for program-specific services like behavioral health, HCBS, LTSS. This has resulted in fewer “wrong payer” denials, faster first-pass acceptance, and reduced manual rework.

Preventing enrollment-related denials caused by NM portal changes

The state of New Mexico have recently shifted the provider enrollment workflows due to which the outdated processes might cause “provider not enrolled” denials, taxonomy/location mismatches and credentialing gaps across MCOs. We at Shoreline Healthcare Technologies manages the end-to-end NM Medicaid provider enrollment and revalidation, and aligns enrollment data with servicing locations, billing NPIs and taxonomy codes required by NM Medicaid and MCOs. Our team proactively audits enrollment status before the claims go out, thereby stopping the enrollment issues becoming a recurring denial source.

Protecting revenue under New Mexico’s strict 90-day timely filing rules

New Mexico’s short filing window leaves little margin for enrollment delays, retro eligibility, or MCO attribution changes. At Shoreline Healthcare Technologies we have the same-day charge capture and claim submission workflows with automated timely filing countdown tracking by payer. So that, all the claims are submitted weeks earlier, minimizing the write-offs tied to filing limits. By combining state-specific expertise, payer-level rules, and process automation, Shoreline Healthcare Technologies helps providers to reduce the denials by 20–40% with shorter days in AR and maintains a predictable cash flow across all the MCOs and FFS billing.

We at Shoreline Healthcare Technologies provide personalized support tailored to the unique needs of New Mexico providers. Our team of experts understands the intricacies of the New Mexico billing landscape and offers guidance to help practices navigate these challenges effectively with our cloud-based RCM solutions for an optimized Revenue Cycle Management.

Comprehensive Medical Billing Services for New Mexico

Specialized Services tailored to meet New Mexico Medicaid rules and regulations

🩺 Services	📍New Mexico Specialization	📈 Typical Improvement	⏱️ Turnaround Time
End-to-End Medical Billing	Complete RCM services with AI-driven tools, payer-specific edits and accurate claim formatting aligned with the state’s Medicaid Fee-For-Service and Turquoise Care MCOs.	25–40% reduction in denial rates with faster reimbursement cycles.	Claims submitted within 24–48 hours
Eligibility & Coverage Verification	Real-time eligibility checks with continuous plan attribution monitoring to detect MCO changes, retro eligibility, and FFS carve-outs.	Reduction in eligibility-related denials by 30–45%	Instant/ Within 24 hours
Prior Authorization Management	MCO-specific PA tracking for behavioral health, LTSS, and high-risk outpatient services	40–60% reduction in PA-related denials	3–5 business days
Provider Enrollment & Revalidation	New Mexico Medicaid enrollment, revalidation, and MCO credentialing, aligned with current state workflows	Eliminates enrollment related denials.	3-4 weeks
Timely Filing Management	Active tracking against NM’s 90-day filing limits, including retro-eligibility and enrollment-delay scenarios	Prevents avoidable write-offs	Ongoing, automated
Denial Management	AI based tools to track and flag denial codes and root-cause analysis tailored for Medicaid claim categories, identifies high-risk categories and automate resubmissions.	Reduce rate of denial by 75% and with quicker appeals.	7–14 days for backlog cleanup; ongoing daily follow-up
Patient Statements & Follow-Up	Communicate with patients and give Explanation of Benefits (EOBs). Includes text/email payment reminders and online payment options.	Reduces overdue balances and increases the collection rates.	1-2 weeks
Audit & Compliance Support	Conducts Audit Review and mock audits, including documentation, encounter verification, and claim reconciliation.	Minimizes risk of penalties and supports successful audits.	Ongoing, depending on audit schedule

Medical Billing Resources for New Mexico

Comprehensive resources specifically designed for Medicaid Providers to navigate the state’s complex Billing Landscape.

Medicaid Billing Guide

A Complete guide covering all billing requirements, policy updates and compliance standards.

Behavioral & Mental Health Billing rules and guidelines

Specialized billing guidelines and documentation procedures for behavioral health programs.

Revenue Cycle Optimization

Best Practices and Strategies to improve cash flow and reduce denials.

Telehealth and Remote patient Monitoring in New Mexico

New Mexico’s telehealth and RPM guidelines and regulations.

Serving Healthcare Providers Across New Mexico

From Bernalillo to Union, we provide comprehensive medical billing services across all 33 New Mexico counties.

Northwest Region:

Cibola, McKinley, San Juan, Sandoval

North Central Region:

Los Alamos, Rio Arriba, Santa Fe, Taos

Central Region:

Bernalillo, Torrance, Valencia

Northeast Region:

Colfax, Guadalupe, Harding, Mora, Quay, San Miguel, Union

Southwest Region:

Catron, Doña Ana, Grant, Hidalgo, Luna, Sierra, Socorro

Southeast Region:

Chaves, Curry, De Baca, Eddy, Lea, Lincoln, Otero, Roosevelt

Savings Estimation Calculator

Practice Type/Speciality

No. of Physicians

Monthly Patient Volume

% of Insurance Pay Patient

% of Self Pay Patient

Frequently Asked Questions

FAQs about Medical Billing Services in New Mexico

Q1. What is YES NM and how does it affect Medicaid billing?

YES NM is New Mexico’s eligibility determination system. It is used to find the start and end dates of the Medicaid eligibility and other retroactive coverage details, they determine whether a claim can be paid or not.

Q2. How can providers verify Medicaid eligibility in New Mexico?

Members eligibility for Medicaid can be verified through

➣ NM Medicaid portal
➣ EDI 270/271 transactions
➣ Respective MCO portals for Turquoise Care members.

Q3. Do providers need separate enrollment for MCOs?

Yes. Enrollment with NM Medicaid does not automatically credential providers with all MCOs. They have to separately register with each MCOs to receive the payment.

Q4. What are the factors that influences the process of onboarding?

➣ Active status of the provider with New Mexico Medicaid and other MCOs
➣ Data access (EHR, clearinghouse, payer portals)
➣ Volume of legacy A/R and denied claims
➣ Scope of services (full RCM vs. partial support)

Q5. What are the initial processes that Shoreline does on onboarding?

➣ Reviews current billing workflows and denial patterns
➣ Confirms New Mexico Medicaid and MCO enrollment status
➣ Sets up payer-specific claim rules and authorization workflows
➣ Transits claims without disrupting the cash flow

Providers can see an increase in clean claim submission within the first few weeks of onboarding, with measurable performance improvements by partnering with Shoreline Healthcare Technologies.

Q6. How can Shoreline Healthcare Technologies help providers in New Mexico?

We at Shoreline Healthcare Technologies handle the entire process of RCM Cycle from patient appointment scheduling to eligibility checks, prior auths, coding, claim submissions, denials, and appeals, till payment processing and patient communication ensuring faster payments and compliance with state specific rules. We also offer analytics and process automation to reduce first pass rejects in state systems and to reconcile managed-care encounter reporting.

Compliance & Certifications

Your data security and compliance are our top priorities.

HIPAA Compliant

Full HIPAA compliance with regular audits

AAPC Certified

Certified Professional Billing Staffs.

New Mexico Licensed

Licensed to operate in New Mexico

Medical Billing Glossary

Essential Terms for Understanding the New Mexico’s Medical Billing Landscape

CareLink NM Health Home

It is the Health Home model under the New Mexico’s Medicaid that focuses on care coordination for members with serious mental illness by integrating the behavioral health, physical health, and social support services under one program. Billing is based on per-member-per-month (PMPM) payments rather than the traditional visit-based claims.

Direct Data Entry (DDE)

The process by which the claims are entered directly into the New Mexico Medicaid system through the Medicaid portal manually. It used for low-volume submitters, claim corrections and in situations where electronic submission is not feasible.

Health Care Authority (HCA)

The agency for overseeing the Medicaid and other public health programs in the state of New Mexico. They administer the Turquoise Care, sets the policies for the Medicaid program, manages contracts with MCOs, and establishes billing, eligibility, and reimbursement rules for providers to follow.

Omnicaid

It is the New Mexico’s Medicaid Management Information System (MMIS) platform that supports eligibility verification, processes claims, generates remittance advice (RA)and manages the provider and member data.

Presumptive Eligibility (PE)

Members are temporarily enrolled in the Medicaid program based on their preliminary information, before the full eligibility is approved formally. They have time-limited coverage and if full eligibility is denied, services rendered during the PE may become non-payable.

Turquoise Care

It is the Managed Care delivery system that integrates Physical health, behavioral health, and long-term services into a single coordinated care system.

Yes New Mexico (YESNM)

The online benefits eligibility and application system used to apply for Medicaid and other public assistance program.

Our Services

Shoreline proudly supports physicians, medical groups, and medical billing companies. Following are the revenue cycle management steps we offer.

Testimonials

My first time in solo practice I was very concerned about my ability to manage "the business side" of medicine. The personalized care and guidance this group provided to me and my staff were really a life saver. They always had quick turnaround on any questions I sent in, and were very knowledgeable for problem solving on the fly! I never feel like just a number, as I might have with a large corporation.

★ ★ ★ ★ ★

Family Medicine Centre in Maine

“We use Shoreline Medical Billing for all our billing needs, the support is second to none! They are always up to date with coding updates which helps to ensure timely billings and prompt payments. I highly recommend Shoreline Medical Billing for your billing needs.”

★ ★ ★ ★ ★

Nephrology Group in New Hampshire

I have been using Shoreline Medical Billing for almost 2 years, and I could not be more pleased with their service. They really care about my business. With all the complexities of medical billing, we needed a professional partner to help us. Shoreline delivered.

★ ★ ★ ★ ★

Pain Management in New Jersey

We switched to Shoreline Medical Billing. Our claims are getting paid, and we are getting friendly, knowledgeable service. We highly recommend Shoreline.

★ ★ ★ ★ ★

Internal Medicine & Nephrology in Georgia

I’m a small pediatric OT practice and have been with Shoreline for several years now. They have made it so easy for me to keep my focus on patient care by being so knowledgeable and so efficient with all aspects of my billing. When I do have questions, they are always available and able to help quickly. Couldn’t be happier!

★ ★ ★ ★ ★

Peds OT Clinic in Maine

Thanks so much for working so hard to help my company:) It sound cheesy, but having a biller I could trust changed my life by giving me the headspace/time to focus on clinical work, scale my business and sleep better at night. I've had quite a few people ask about you on Facebook Messenger from my posts. Overall, the feedback I've heard back from everyone is that you guys are very responsive and helpful.

★ ★ ★ ★ ★

Nurse Practitioner Group in Washington

Hi, following up on our conversation about Shoreline. I did let them know that I had some concerns and they were very understanding. They have been very responsive and proactive in their billing process, reports and communication. It has been very good. Thank for recommending them.

★ ★ ★ ★ ★

Nurse practitioner in Delaware

Before Shoreline, billing was a constant headache. Now, our reimbursements are faster, and I’m no longer chasing unpaid claims. Their team handles everything so efficiently, it’s one less thing I need to worry about.

★ ★ ★ ★ ★

Internal Medicine in Arizona

We Care

From electronic health records, billing services and practice management tools-Shoreline has you covered! In addition to being industry leader when it comes to pricing, we also provide personalized support for every client, with a team of experts who have worked with physicians and medical groups for years, Shoreline Healthcare Technologies in New Mexico understands how to navigate today’s complex healthcare revenue environment.

Ready to Optimize Your Medical Billing?

Get your free consultation and discover how much you could save with our New Mexico -specialized billing services.

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Contact Information

445 Main Street, 2nd Floor, #1, Saco, ME 04072
1-855-838-1370
info@shorelinemb.com
M-F, 9am - 5pm EST

Why work with us?

✔ 40% average denial rate reduction
✔ Local billing expertise
✔ 24-48 hour claim turnaround
✔ Dedicated New Mexico support team

The Best Medical Billing Company in New Mexico - Shoreline

Best In the Industry

New Mexico Billing Challenges we solve

Eliminating Managed Care vs Fee-For-Service confusion

Preventing enrollment-related denials caused by NM portal changes

Protecting revenue under New Mexico’s strict 90-day timely filing rules

Comprehensive Medical Billing Services for New Mexico

Medical Billing Resources for New Mexico

Medicaid Billing Guide

Behavioral & Mental Health Billing rules and guidelines

Revenue Cycle Optimization

Telehealth and Remote patient Monitoring in New Mexico

Serving Healthcare Providers Across New Mexico

Northwest Region:

North Central Region:

Central Region:

Northeast Region:

Southwest Region:

Southeast Region:

Savings Estimation Calculator

Frequently Asked Questions

Q1. What is YES NM and how does it affect Medicaid billing?

Q2. How can providers verify Medicaid eligibility in New Mexico?

Q3. Do providers need separate enrollment for MCOs?

Q4. What are the factors that influences the process of onboarding?

Q5. What are the initial processes that Shoreline does on onboarding?

Q6. How can Shoreline Healthcare Technologies help providers in New Mexico?

Compliance & Certifications

HIPAA Compliant

AAPC Certified

New Mexico Licensed

Medical Billing Glossary

CareLink NM Health Home

Direct Data Entry (DDE)

Health Care Authority (HCA)

Omnicaid

Presumptive Eligibility (PE)

Turquoise Care

Yes New Mexico (YESNM)

Our Services

Testimonials

Family Medicine Centre in Maine

Nephrology Group in New Hampshire

Pain Management in New Jersey

Internal Medicine & Nephrology in Georgia

Peds OT Clinic in Maine

Nurse Practitioner Group in Washington

Nurse practitioner in Delaware

Internal Medicine in Arizona

We Care

Ready to Optimize Your Medical Billing?

Get Your Free Consultation

Contact Information

Why work with us?