Revised Adjustment, Reconsideration and Void Request Forms

New Mexico Medicaid has revised the Adjustment, Reconsideration and Void Request Forms to better assist providers and reduce the number of returns. The Adjustment / Void Request Forms have been consolidated into one form. Submission instructions for the revised Adjustment/Void and Reconsideration Request Forms are included in each form. The forms can be found on the New Mexico Medicaid Web Portal. After October 1st, 2017 Conduent will no longer accept older versions of Adjustment, Reconsideration or Void Request Forms and will return to provider.

Source: https://nmmedicaid.acs-inc.com/static/ProviderInformation.htm