New Mexico Administrative Code
Title 8 - SOCIAL SERVICES
Chapter 308 - MANAGED CARE PROGRAM
Part 2 - PROVIDER NETWORK
Section 8.308.2.13 - SPECIALTY PROVIDERS
Universal Citation: 8 NM Admin Code 8.308.2.13
Current through Register Vol. 35, No. 18, September 24, 2024
The MCO shall contract with a sufficient number of specialists with the applicable range of expertise to ensure that the needs of the members are met within the MCO's provider network. The MCO shall also have a system to refer members to non-contracted providers if providers with the necessary qualifications or certifications do not participate in the network. Out-of-network providers must coordinate with the MCO with respect to payment. The MCO must ensure that cost to its member is no greater than it would be if the services were furnished within the network.
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