N.M. Admin. Code § 8.350.3.11 - SUBMITTING ABSTRACTS FOR RETROACTIVE PRIOR APPROVAL REVIEW

A. To request retroactive prior approval review, a facility must submit the abstract, a request for retroactive prior approval review form and supporting documentation to the UR contractor. Facilities must provide at least the following supporting documentation:

(1) pertinent information, such as physician orders, history and physical, physician progress notes or hospital discharge summaries; all documentation must be date-stamped by the facility verifying date of receipt from the physician or hospital.

(2) dated facility entries and records that document telephone calls to physicians reminding them of the need to complete the abstract, physician orders, history and physical or progress notes;

(3) date-stamped copy of the notification of medicaid eligibility; and

(4) documentation of other reasons for delay.

B. Any request for retroactive prior approval review received without the required supporting documentation is returned to the facility.

Notes

N.M. Admin. Code § 8.350.3.11

11/1/96; 8.350.3.11 NMAC - Rn, 8 NMAC 4.MAD.954.2, 3/1/12