N.M. Admin. Code § 8.326.8.17 - REIMBURSEMENT
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. Instructions on documentation, billing and claims processing are sent to approved medicaid providers.
A.
Reimbursement for non-governmental
providers: For community agencies, tribal government, or Indian health
services, reimbursement for case management services is made at the lesser of
the following:
(1) the provider's billed
charge; or
(2) the MAD fee schedule
for the specific service or procedure.
B. The provider's billed charge must be the
provider's usual and customary charge for services.
C. "Usual and customary charge" refers to the
amount which the individual provider charges the general public in the majority
of cases for a specific procedure or service.
D.
Reimbursement for governmental
providers: For case management services rendered by governmental
agencies to the target population, reimbursement rates, rate setting
methodology and reimbursement process will be delineated under the terms of the
joint powers agreement between the government agencies and the human services
department.
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.