New Mexico Administrative Code
Title 7 - HEALTH
Chapter 30 - FAMILY AND CHILDREN HEALTH CARE SERVICES
Part 3 - CHILDREN'S MEDICAL SERVICES AND ADULT CYSTIC FIBROSIS
Section 7.30.3.13 - PROVIDER BILLING
Current through Register Vol. 35, No. 18, September 24, 2024
A. Providers must seek payment from insurance, medicaid, and other sources, if known, prior to billing the children's medical services program. This includes billing the medicaid program using the child's recipient medicaid identification number and not the CMS billing number.
B. Inpatient care shall be paid at the negotiated per diem rate and under the term established by the provider participation agreement. For other services covered under the program; including approved inpatient days, providers must agree to accept as payment in full the amounts established by the division.
C. If a provider receives a payment from a source other than the program which is equal to or exceeds the amount of the program fee schedule for the authorized services rendered, the provider is prohibited from seeking additional payment from either the client or the division.
D. Providers must submit all bills to the fiscal agent for payment on forms prescribed by the program and within the billing time limits established by the program. Unless the provider receives a waiver of the time limit from the program manager and medical director, failure to comply with the time limits may result in denial of claim. Providers may not hold clients responsible for bills denied because of failure to meet time limits. Providers must also follow all billing instructions in submitting claims for payment to the fiscal agent. If claims are denied due to not following instructions, providers may not hold clients responsible for payment of these bills.
