N.M. Admin. Code § 8.302.1.10 - ELIGIBLE PROVIDERS
A. Upon
the approval of a New Mexico MAD provider participation agreement by MAD or its
designee, a licensed practitioner or facility that meets applicable
requirements is eligible to be reimbursed for furnishing covered services to an
eligible program recipient. A provider must be enrolled before submitting a
claim for payment to the appropriate MAD claims processing contractor. MAD
makes available on the HCA/MAD website, on other program-specific websites, or
in hard copy format, information necessary to participate in health care
programs administered by HCA or its authorized agents, including program rules,
billings instructions, utilization review instructions, and other pertinent
materials. When enrolled, providers receive instructions on how to access these
documents. It is the provider's responsibility to access these instructions or
ask for paper copies to be provided, to understand the information provided and
to comply with the requirements. The provider must contact HCA or its
authorized agents to request hard copies of any program rules manuals, billing
and utilization review instructions, and other pertinent materials and to
obtain answers to questions on or not covered by these materials. To be
eligible for reimbursement, a provider is bound by the provisions of the MAD
provider participation agreement and all applicable statutes, regulations and
executive orders.
B. When services
are billed to and paid by a coordinated services contractor authorized by HCA,
the provider must also enroll as a provider with the coordinated services
contractor and follow that contractor's instructions for billing and for
authorization of services.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.