New Mexico dental billing changed fundamentally when two new Turquoise Care MCOs replaced Western Sky in July 2024. Out-of-state generalist vendors consistently underestimate this complexity. TransDontics’s 1,100+ specialists manage your complete revenue cycle from eligibility through final payment.
New Mexico practices navigate a four-MCO Turquoise Care structure that launched July 2024, replacing Centennial Care with two new MCOs joining two incumbents. 3 MCOs route dental through DentaQuest while the fourth operates separately. Record-retention obligations under 16.5.1 NMAC add further complexity for out-of-state vendors.
Turquoise Care and the Four-MCO Transition
DentaQuest as Shared Dental Benefits Manager
DSO Expansion and the Albuquerque Market Pressure
HIPAA and New Mexico's Dental Record-Retention Requirements
TransDontics’s 1,100+ in-house dental billing specialists are supported by RPA automation engineered for New Mexico’s dental billing environment. Every process is designed around the actual payer rules, fee schedules, and documentation standards your claims will face.
TransDontics combines RPA automation with specialist judgment. RPA handles eligibility, claim scrubbing, status tracking, and payment posting while specialists handle DentaQuest authorization escalations, IHS routing, EOB reconciliation, and MCO transition disputes.
Every payment is reconciled against your contracted rate, line by line. When any payer settles below the agreed fee, we flag it and appeal within 14 days including the gap between DentaQuest authorizations and actual contracted rate payments that most practices never catch.
Before every Turquoise Care claim, we confirm MCO enrollment, route through DentaQuest or UnitedHealthcare's separate portal, verify Native American eligibility, and apply correct prior auth requirements. MCO assignment changes are caught before they create A/R rejections.
Claims processed within 48 hours of receipt. No setup fee, no monthly minimum, no long-term contract, and nothing buried in the fine print. Our fee is a nominal percentage of what we successfully collect from payers on your behalf. We earn when you get paid.
Expert CDT coding, clean claim submission, and aggressive denial management by specialty-certified billers. 98% first-pass clean claim rate.
No claim goes 48 hours without follow-up. We pursue every outstanding balance across all payers until it is paid, appealed or written off.
Get in-network faster. We handle all payer paperwork, CAQH maintenance, renewals, and compliance tracking so you start seeing insured patients.
Full revenue cycle coverage from patient registration to final payment. We manage all claims, close every gap, and maximize your collections.
Strategic oversight of your practice’s operational and financial performance. We track collections, payer mix, and productivity metrics
Complete front office billing support covering patient billing inquiries, insurance comms, prior auth, and appointment-linked verification.
HIPAA-compliant dental transcription delivered fast and accurately. Clinical notes, procedure documentation, and patient records are transcribed.
We review your last 12 months, find your top 3 revenue leaks, and show you exactly what we fix. Practices often discover recoverable revenue.
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An in-house biller knows your practice, not DentaQuest’s MCO-specific authorization differences, IHS-eligible MCO handling, or Turquoise Care patient reassignments. Turnover resets that knowledge. Ours doesn’t.
Most billing companies submit claims. They won’t catch DentaQuest prior auth mismatches, verify Native American eligibility routing, or recover underpayments. TransDontics does all of it.
Most billing companies are a service. TransDontics is a system; RPA catching what human review misses at volume, experienced billers catching what automation cannot judge. The result is a first-pass rate of 98%.
Three steps. No disruption. No risk.
We connect directly to Dentrix, Eaglesoft, or your existing PMS. No migration, no new systems, no disruption.
Three steps. No disruption. No risk.
We review your claims, A/R, and denial patterns at zero cost. Most practices find 5–10% in hidden revenue leakage.
We connect directly to Dentrix, Eaglesoft, or your existing PMS. No migration, no new systems, no disruption.
We don’t publish named case studies because most clients prefer to keep billing performance private. What we can share is what the numbers look like across practices with comparable payer profiles.
Based on aggregated results across dental practices in comparable payer environments.
| Metric | Before TransDontics | After TransDontics |
|---|---|---|
| Average Denial Rate | 8–12% | Under 2.3% |
| First-Pass Clean Claim Rate | 70–80% | 98% |
| A/R Over 90 Days | 30–40% of Total AR | Reduced by 30%+ |
| Average A/R Resolution | 45+ Days | 18–25 Days |
| Claim Turnaround | 3–5 Days | 48 Hours |
| Revenue Growth (120 days) | Baseline | 5–12% Increase |
An Albuquerque practice came to us with an 11% denial rate, 36% of A/R past 90 days, and Turquoise Care claims still routing through expired Western Sky credentialing months after the July 2024 transition with 2–3 hours daily of inconsistent billing follow-up.
Our specialists know every New Mexico payer’s rules and appeal processes. National billing companies stumble on Turquoise Care’s MCO structure, DentaQuest prior auth distinctions, and Native American eligibility routing. We don’t.
Incumbent Turquoise Care MCO administering dental through DentaQuest with age-stratified coverage and authorization rules. We track BCBSNM-specific DentaQuest policy updates continuously.
New Turquoise Care MCO managing dental through its own portal rather than DentaQuest, requiring a separate credentialing & claims workflow. We maintain active enrollment & manage UnitedHealthcare submissions as a dedicated process.
TransDontics knows DentaQuest prior auth requirements differ across BCBSNM, Presbyterian, and Molina members, UnitedHealthcare routes through a separate portal, and Native American MCO enrollees retain IHS access requiring verification before every submission.
Every New Mexico practice qualifies. If your city isn’t listed, it’s coming. Reach out now and we’ll onboard your practice without delay.
Every state has its own payer rules, Medicaid structure, and billing landmines. TransDontics expertly navigates all of them.
New Mexico practices carry HIPAA obligations alongside 16.5.1.24 NMAC’s six-year record retention and the Data Breach Notification Act extending security obligations beyond HIPAA. TransDontics is independently certified under all applicable frameworks.
All patient data is encrypted end-to-end, satisfying HIPAA Security Rule technical safeguards and the reasonable security procedures required under New Mexico's Data Breach Notification Act. Every transmission meets the highest applicable standard; not just the federal floor.
Only credentialed TransDontics personnel access your practice data. This eliminates the internal access vulnerabilities that turn in-house billing into a compliance liability most New Mexico practice owners don't realize they're carrying. Unauthorized disclosure of patient information carries potential civil liability under both HIPAA and New Mexico's state-level confidentiality framework.
Our AICPA SOC 2 Type II certification is independently audited and renewed annually. It is not a self-assessment; it is third-party-verified proof of our security posture, documented and on file. Your New Mexico practice's liability exposure under both federal and state compliance frameworks is measurably reduced from day one of our partnership.
Customized billing solutions based on your specialty
In-house billing looks cheaper on paper. It rarely is once you account for salary, benefits, turnover, training costs, software, and the revenue lost to Turquoise Care errors, DentaQuest auth mismatches, and Native American eligibility routing. TransDontics’s fee is a percentage of what you actually collect. That is the whole model.
Average New Mexico salary
*Salary benchmarks based on New Mexico Glassdoor, ZipRecruiter, and BLS data. Results vary by practice size and payer mix.
Our Complimentary audit covers denied claims, MCO routing errors, and underpayments, no obligation, no pitch.
Yes. The New Mexico Board of Dental Health Care, operating under the Dental Health Care Act (Sections 61-5A-1 through 61-5A-29 NMSA 1978) and 16.5.1 NMAC, sets record-keeping standards that directly affect claim documentation and audit defensibility. The record-keeping rule requires documentation sufficient to demonstrate the basis for treatment decisions and continuity of care. Third-party payer reviews of dental records; explicitly addressed in 16.5.1.21 NMAC, require the reviewing dentist’s license number and the insurer’s name to be on file with the board. Our team ensures every claim submitted for your New Mexico practice satisfies both Turquoise Care and commercial payer requirements alongside Board standards simultaneously.
No setup fee. No monthly minimum.
Cancel anytime.
Response within 24 hours.
Pay only a percentage of what we collect for you
