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It explains how managed care operates, why doula and lactation services matter for Medicaid members, and what providers must do to join the system, get approved, and begin billing. The guide covers credentialing and contracting, CAQH and NUCC processes, MCO-specific steps, claim submission, common billing errors, and linking services to maternal-child HEDIS measures.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/doula-and-lactation-provider-managed-care-reference-guide-2026/283952/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/doula-and-lactation-provider-managed-care-reference-guide-2026/283952.png","ImageObject",442,249,{"name":88,"@type":89},"Aditya","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-23","2026-09-17",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",9,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What is the purpose of the Doula and Lactation Provider Managed Care Reference Guide?","Question",{"text":109,"@type":110},"It helps doulas and lactation providers understand how to work with New Mexico Medicaid MCOs, including the steps to join the system, become approved, and start billing for services.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"What credentialing and contracting steps are covered in the guide?",{"text":114,"@type":110},"The guide outlines an overview of contracting/credentialing, key terms, general steps to contract with MCOs, and tips to prepare successful applications, including credentialing processes for doulas and lactation providers.",{"name":116,"@type":107,"acceptedAnswer":117},"How does the guide explain billing and claims submission?",{"text":118,"@type":110},"It covers covered services and billing codes, required documentation, how to submit a claim, and common billing mistakes to avoid when billing for doula and lactation services.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},283952,1790235831,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":136,"language":137,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":138,"faqs":139,"seo_title":140,"seo_description":61,"update_tm":141,"read_time":15},962085564549,"https://ap-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","2026  \nDoula and Lactation Provider  \nManaged Care  \nReference Guide  \nIn collaboration with Blue Cross Blue Shield of NM, Molina NM, Luminar Health, Presbyterian Health Plan, United Health Care NM, New Mexico Doula Association ( NMDA), New Mexico Breastfeeding Task Force ( NMBTF), New Mexico Department of Health ( NMDOH), and other community partners.  \nIntroduction  \nThe Doula and Lactation Provider Managed Care Reference Guide was created to help doulas and lactation providers who want to work with New Mexico’s Medicaid Managed Care Organizations ( MCOs). These providers offer important care and support for our members, families, and this guide gives them the steps they need to join the system, get approved, and start billing for their services.  \nThis guide is the result of a team effort led by all four New Mexico MCOs, Department of Health, along with the New Mexico Doula Association, The New Mexico Breastfeeding Taskforce, as well as other community partners. Together, we created this guide to make the process easier to understand. It includes the most important steps and helpful information providers need to get started and be successful.  \nDoulas and lactation providers play a big role in improving the health of our communities, especially for families who need extra support. This guide is one way we can support their work and help them connect with more people.  \nDOULA AND LACTATION PROVIDER MANAGED CARE REFERENCE GUIDE PAGE 2  \nTable of Contents  \n1. Understanding Medicaid Managed Care in New Mexico ........................................... Pg. 5  \no Overview of Managed Care and MCOs  \no The Role of Doulas and Lactation Providers in Supporting Medicaid Members  \no Why This Work Matters  \n2. Credential Requirements .................................................................................................................. Pg. 6  \no Doula State Credentialing Process  \no Lactation Certification Process Yes  \no NM-Becoming a Medicaid Provider  \n3. What is YesNM ......................................................................................................................................... Pg. 11  \no Why It Matters  \no What You’ll Use It For  \no Common Barriers Doulas & Lactation Consultants Face  \no What You’ll Need Before You Start  \no Pro Tips  \n4. Credentialing and Contracting Overview ......................................................................... Pg. 12  \no What Is Contracting/ Credentialing and Why It Matters  \no Important Terms You Should Know  \no General Steps to Contract with MCOs  \no Tips to Prepare for a Successful Application  \n5. CAQH Registration & NUCC Grouping ................................................................................... Pg. 14  \n6. MCO-Specific Credentialing and Contracting Processes .................................... Pg. 16  \no  Blue Cross Blue Shield of New Mexico ................................................................... Pg. 16  \n Key Contacts  \n Step-by-Step Process  \n Provider Portal Information  \n Who to contact for help  \no  Molina Healthcare ............................................................................................................... Pg. 18  \n Key Contacts  \n Step-by-Step Process  \n Provider Portal Information  \n Who to contact for help  \no  Presbyterian Healthcare ............................................................................................... Pg. 23  \n Key Contacts  \n Step-by-Step Process  \n Provider Portal Information  \n Who to contact for help  \no  United Healthcare ............................................................................................................... Pg. 26  \n Key Contacts  \n Step-by-Step Process  \n Provider Portal Information  \n Who to contact for help  \nDOULA AND LACTATION PROVIDER MANAGED CARE REFERENCE GUIDE PAGE 3  \n7. Billing for Doula and Lactation Services ............................................................................. Pg. 29  \nCovered Services and Billin","cbCaia4VxfFBV68D","https://ap.wps.com/l/cbCaia4VxfFBV68D","pdf",1833796,34,"English","# Understanding Medicaid Managed Care in New Mexico\n## Overview of Managed Care and MCOs\n## The Role of Doulas and Lactation Providers in Supporting Medicaid Members\n## Why This Work Matters\n# Credential Requirements\n## Doula State Credentialing Process\n## Lactation Certification Process\n## NM-Becoming a Medicaid Provider\n# What is YesNM\n## Why It Matters\n## What You’ll Use It For\n## Common Barriers Doulas & Lactation Consultants Face\n## What You’ll Need Before You Start\n## Pro Tips\n# Credentialing and Contracting Overview\n## What Is Contracting/ Credentialing and Why It Matters\n## Important Terms You Should Know\n## General Steps to Contract with MCOs\n## Tips to Prepare for a Successful Application\n# CAQH Registration & NUCC Grouping\n# MCO-Specific Credentialing and Contracting Processes\n## Blue Cross Blue Shield of New Mexico\n## Molina Healthcare\n## Presbyterian Healthcare\n## United Healthcare\n# Billing for Doula and Lactation Services\n## Covered Services and Billing Codes\n## Required Documentation\n## How to Submit a Claim\n## Common Billing Mistakes and How to Avoid Them\n# Linking Doula & Lactation Services to Maternal-Child HEDIS Measures\n## Overview of HEDIS and Quality Measures\n## How Your Services Impact Member Outcomes\n## Supporting Care Coordination and Preventive Care\n# MCO Provider Directories\n## Quick Links to MCO Provider Portals and Resources\n# Appendices\n## Summary of Value-Added Services by MCO\n## Turquoise Care Rewards Information\n## Food is Medicine\n## Resources","[{\"question\":\"What is the purpose of the Doula and Lactation Provider Managed Care Reference Guide?\",\"answer\":\"It helps doulas and lactation providers understand how to work with New Mexico Medicaid MCOs, including the steps to join the system, become approved, and start billing for services.\"},{\"question\":\"What credentialing and contracting steps are covered in the guide?\",\"answer\":\"The guide outlines an overview of contracting/credentialing, key terms, general steps to contract with MCOs, and tips to prepare successful applications, including credentialing processes for doulas and lactation providers.\"},{\"question\":\"How does the guide explain billing and claims submission?\",\"answer\":\"It covers covered services and billing codes, required documentation, how to submit a claim, and common billing mistakes to avoid when billing for doula and lactation services.\"}]","Doula and Lactation Provider Managed Care Reference Guide - 2026 | PDF",1789623417]