FAQs

Who can join the SWBHIPA?

SWBHIPA is comprised of social workers, counselors, family therapists, art therapists, psychologists, psychiatric nurses and psychiatrists from all over the state of New Mexico.

What are the benefits of joining SWBHIPA?

As a Member of SWBHIPA, you will have the benefit of staff who will guide our organization and assist with contracting with insurance companies on your behalf.

  • As a Member of the IPA, you will select the contracts in which you want to participate.
  • Our consultant staff will assist Members in understanding the IPA contract language and advocate for standardization of contracts.
  • Included in the contract will be clear and defined reimbursement schedules.
  • The IPA will provide education on contracting and balloting.
  • The IPA offers many opportunities for networking and building a strong community of quality mental health providers, to which you can belong and refer.

What types of identifiers and registrations do I need to become a member?

  • National Provider Identifier (NPI) number

Every provider needs to obtain a National Provider Identifier (NPI) number.  If you are a solo provider and bill under your SSN, then you need an NPI for yourself (Type 1 NPI).  If you bill under an EIN, then you need to obtain an NPI number your EIN/group (Type 2 NPI) in addition to your Type 1

Information on applying for an NPI

National Plan & Provider Enumeration System (NPPES)
[where you can create an account and apply for a NPI number(s)]

  • CAQH/Proview

CAQH is a credentialing data base that most insurance companies use to credential you.  You need to enroll in their system, load your information and credentialing documents into this system and you will be assigned a CAQH number, which you will submit to plans when you apply to join and credentialing with them.  It is important that you keep your information current in their system and re-attest every three (3) months.
CAQH Quick Reference Guide
CAQH/ProView Login

  • Medicaid/Centennial

To provide services for Medicaid/Centennial, first you must enroll with the State’s Medicaid program.  Once you obtain your Medicaid number, you then must contract with the insurance companies that administer the State’s Medicaid program (BCBS, Presbyterian, United and Molina). 
An individual and a group must each register and obtain a Medicaid number.   This is done through Conduent, the vendor the State uses.    The Provider Relations Helpdesk can be contacted at NMPRSupport@Conduent.com or 1-800-299-7304 or 505-246-0710.
**Medicaid Application Tips
Medicaid FAQ
Enrollment Portal
If you are unable to submit an application online, click the appropriate link to print the MAD335 or MAD312 paper application or contact the Provider Relations Helpdesk for assistance at NMPRSupport@Conduent.com or 1-800-299-7304 or 505-246-0710.

What if I am not currently on any insurance panels?

SWBHIPA Members have access to the IPA contracts (subject to some limitations due to plan imposed network closures). If you choose to panel with one of the contracts the IPA works with, we will assist you with the application process, most of which can be done without completing the MCO’s applications.

How does contracting work?

When you are approved by the Board to join the IPA, you will be given access to our provider portal.  There, you can review our current contracts (some reimbursement terms may be restricted, as those can be proprietary and individual.)  Once you have reviewed those that you are interested in, you can choose which ones you would like to join. This process is called “balloting.” Your ballot is not accessible to other providers and only seen by IPA staff, who work directly with the insurance companies.

What if I want to contract directly with an insurance company the IPA is also working with?

The IPA will never discourage providers from working with payers directly. If you like the contract you have, you can keep it. You decide which IPA contracts you wish to join.

Can the IPA contract as a group?

The IPA utilizes the “Messenger Model” of negotiation, which is completely confidential, permissible and legal. We highly recommend that all Members educate themselves about antitrust issues. We have in-depth antitrust information under the tab labeled “antitrust laws” and an antitrust policy that members will sign.

How is my confidential information protected?

All information given to the IPA is strictly confidential and will not be shared with other Members or other outside companies. Member information will only be shared with Insurance Companies with whom Members choose to participate.

How will my current practice change?

Since we are a membership organization, joining the IPA does not change the way you run your practice. You will continue to operate your business as usual, using your current staff and billing personnel, tax ID, etc. You will simple enjoy the “Membership Benefits” of SWBHIPA, such as contracting, networking opportunities and education.

What kind of Continuing Education (CE) does the IPA offer?

The IPA promotes quality continuing education opportunities that are offered by our fellow members, often with discounts to our Members. The IPA focuses on updating our Members on current, timely issues that affect our practices.

Does the IPA have any legislative power?

Besides contracting, networking and educational purposes, we have developed a legislative committee to address the issues which affect our Members and the committee works collaboratively with other professional organizations involved in advocacy related to our work.  These issues are carefully defined and approved of by the Board of Directors. 

What happens if I decide not to join after I have submitted my application or renew my membership?

SWBHIPA has an initial 30 day period in which you can change your mind for a full refund.  After that time, dues will be assessed annually.  There will be no partial refunds given if withdrawal occurs mid-year.

If I decide not to renew my Membership in the future, what happens to my IPA contracts?

If you should decide to discontinue your membership with SWBHIPA, you will be terminated from the SWBHIPA contracts and you will need to contract directly with any of the insurance contracts that you were participating in through SWBHIPA. This may entail submitting new applications or letters of intent with the insurance companies, possibly going through their credentialing process again.  You will need to negotiate and execute direct contracts with the insurance companies.  Again, you will need to reapply and negotiate a direct contract with any of the insurance companies with which you want to continue participation.