Providers who furnish services to medicaid recipients must
comply with all federal and state laws and regulations relevant to the
provision of medical services, including but not limited to, Title XIX of the
Social Security Act, the Medicare and Medicaid Anti-Fraud Act, and the state
Medicaid Fraud Act. Providers also agree to conform to MAD policies and
instructions as specified in this manual and its appendices, as updated. See
8.302.1 NMAC, General Provider Policies.
A. Recipient eligibility determination:
Providers must verify that services they furnish are provided to eligible
recipients.
(1) Providers may verify
eligibility through several mechanisms, including the use of an automated voice
response system, contacting the medicaid fiscal agent contractor eligibility
help desk, contracting with a medicaid eligibility verification system (MEVS)
vendor, or contracting with a medicaid magnetic swipe card vendor.
(2) Providers must verify that recipients are
eligible for medicaid throughout periods of continued or extended services. By
verifying client eligibility, a provider is informed of restrictions that may
apply to a recipient's eligibility.
B. Requirements for updating information:
Providers must furnish in writing to MAD or MAD claims processing contractor
with complete information on changes in their address, license, certification,
board specialties, corporate name or corporate ownership, and a statement as to
the continuing liability for the provider for any dissolution of other
disposition of the health care provider or person. MAD or the MAD claims
processing contractor must receive this information at least 60 days before the
change. Any payment made by MAD based upon erroneous or outdated information is
subject to recoupment.
C.
Documentation requirements: Providers must maintain records to fully disclose
the nature, quality, amount, and medical necessity of the services furnished to
recipients who are currently receiving or who have received medical services in
the past 42 CFR
431.107(b). Documentation
supporting medical necessity must be legible and available to medicaid upon
request. See
8.302.1 NMAC,
General Provider
Policies.
