New Mexico Administrative Code
Title 8 - SOCIAL SERVICES
Chapter 200 - MEDICAID ELIGIBILITY - GENERAL RECIPIENT POLICIES
Part 430 - RECIPIENT RIGHTS AND RESPONSIBILITIES
Section 8.200.430.16 - ELIGIBLE RECIPIENT FINANCIAL RESPONSIBILITIES
Current through Register Vol. 35, No. 18, September 24, 2024
A. A MAD provider agrees to accept the amount paid as payment in full. A provider cannot bill an eligible recipient for any unpaid portion of the bill (balance billing) or for a claim that is not paid because of a provider administrative error or failure of multiple providers to communicate eligibility information.
B. Failure of an eligible recipient to follow his or her privately held health insurance carrier's requirements: An eligible recipient must be aware of the physician, pharmacy, hospital, and other providers who participate in his or her HMO or other managed care plan. An eligible recipient is responsible for payment for services if he or she uses a provider who is not a participant in his or her plan or if he or she receives any services without complying with the rules, policies, and procedures of his or her plan.
C. Other eligible recipient payment responsibilities: If all the following conditions are met before a MAD service is furnished, the eligible recipient can be billed directly by a MAD provider for services and is liable for payment: