New Mexico Administrative Code
Title 8 - SOCIAL SERVICES
Chapter 285 - MEDICAID ELIGIBILITY - EMERGENCY MEDICAL SERVICES FOR NONCITIZENS
Part 600 - BENEFIT DESCRIPTION
Section 8.285.600.11 - INITIAL BENEFITS
Current through Register Vol. 35, No. 18, September 24, 2024
Applications for medicaid must be acted on within 45 days of the date of application.
A. If an applicant is eligible for medicaid, the individual is sent a notice of case action (NOCA) form. The approval of financial eligibility is not a guarantee that medicaid will pay for the services. The NOCA form also serves as notice of case closure, since medicaid covers only emergency services received during the specified term of the emergency. The provider is sent the decision for emergency medical services for non-citizens (EMSNC) application (MAD 778) form. The provider must use the MAD 778 form to submit claims to the medicaid utilization review contractor for emergency review.
B. If an applicant is ineligible for medicaid or a decision on the application is delayed beyond the 45 day time limit, the individual is sent a NOCA form regarding the application for EMSNC. The NOCA form explains the reason for denial or delay and informs the applicant of their right to an administrative hearing. If the application is denied, the applicant must notify providers of the denial.
C. The applicant is responsible for payment for the medical services if they fail to apply promptly for coverage, verify eligibility for coverage, or notify the provider of the approval or denial of the application.
