N.M. Admin. Code § 8.326.7.17 - REIMBURSEMENT
A. Case management
providers must submit claims for reimbursement on the HCFA-1500 claim form or
its successor. See 8.302.2 NMAC, Billing for Medicaid
Services. Once enrolled, instructions on documentation, billing and
claims processing are sent to the medicaid providers. Reimbursement for case
management providers is made at the lesser of the following:
(1) the provider's billed charge;
or
(2) the MAD fee schedule for the
specific service.
B. The
provider's billed charge must be its usual and customary charge for the
services.
C. "Usual and customary
charge" refers to the amount which an individual provider charges the general
public in the majority of cases for a specific procedure or service.
D. For case management services furnished by
an institution, costs associated with case management must be removed from
their cost reports prior to any cost settlement or rebasing.
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.