MedicaidAdministrativeHigh impact
Supplement 26-03: ICF/IID Claims – Recoupment of Claims with Identical Billing and Attending Providers NPIs
New Mexico Medicaid·NM·Claims & Billing
Effective date
May 1, 2026
We identified it
Jun 23, 2026
Summary
New Mexico Medicaid will begin monthly retrospective reviews of ICF/IID claims starting May 1, 2026 to identify claims where the billing provider NPI and attending provider NPI are identical. Claims with matching NPIs will be subject to recoupment as they violate federal Medicaid requirements that the attending provider must be an individual practitioner separate from the billing facility.
Action Required
Immediately: ICF/IID billing teams must review all claim submission processes to ensure attending provider NPIs are never the same as billing facility NPIs. Update billing system edits to reject claims with identical billing and attending provider NPIs. For claims submitted through Turquoise Claims system, ensure attending provider field is populated with enrolled individual practitioner NPI. Review all claims from May 1, 2026 forward as they will be subject to monthly retrospective reviews and potential recoupment if non-compliant.