• New Mexico Medicaid Portal

Provider Enrollment Application

NM Medicaid is now accepting TEMPORARY PROVISIONAL applications for temporary provider enrollment during the Public Health Emergency. Provisional Enrollment is temporary , not to be used for permanent enrollment of New Mexico Medicaid providers. Provisional enrollment will end after the Public Health Emergency. The MAD Provisional Provider Participation Agreement (PPA) is intended for providers who are 1) providing COVID-19 related services to Medicaid recipients and 2) not currently enrolled in the New Mexico Medicaid program.

Providers may be required to include licensure or certification documentation with the Provisional enrollment applications.

If you are unsure if you or your organization are already enrolled in the New Mexico Medicaid program, please use the Provider Search tool to verify status. If you have any further questions or need assistance, please contact the Consolidated Customer Service Center (CCSC) at 1-800-299-7304.

Create a New Application
Please enter your email address and click CREATE
Recall Your Existing Application
To recall an application that you have partially completed, enter your reference number and click RECALL
Forgot Your Reference Number?
If you have forgotten your reference number, please enter your email address below and click SUBMIT. The email address you submit will be validated against the one on file for you and your reference number will be sent to you by email.
Reopen and Resubmit Your Returned Application
To reopen a submitted application that has been returned for missing or incomplete information
Submit Reverification Response
Please enter your email address and click CREATE