ODM Provider Credentialing Requirements

Beginning October 1, 2022 new credentialing requirements for Medicaid providers will become effective as outlined in ODM’s new credentialing rule (5160-1-42). This rule implements national credentialing standards for independently licensed providers and will be required as part of Medicaid procurement and the effort towards centralized credentialing and the transition to the PNM. This rule provides the process and requirements ODM will follow for applicable providers that require credentialing for their specific provider type. This rule also identifies the required information needed to complete the credentialing process and details any additional actions necessary on behalf of the provider or facility to complete credentialing. See paragraph (B) of the rule for the list of practitioners required to complete credentialing and paragraph (E) for the information required. See paragraph (C) of the rule for the list of facilities required to complete credentialing and paragraph (F) for the information required. 

ODM will align initial credentialing for independently licensed providers with the provider’s Medicaid revalidation date and is currently planning to resume provider revalidation beginning October 1. Providers will receive notification in the PNM 120 days in advance of their revalidation/credentialing date. ODM’s plan is to disperse revalidations over the timeframe allowed by CMS, meaning not all providers will revalidate/credential at the start of the process.  Independently licensed providers will complete one application in the PNM that will cover both the credentialing and enrollment/revalidation requirements. Providers can prepare for the credentialing process now by ensuring independently licensed practitioners have established profiles with the Council for Affordable Quality Health (CAQH), as this is a requirement of the ODM credentialing rule.