New Mexico Administrative Code
Title 8 - SOCIAL SERVICES
Chapter 310 - HEALTH CARE PROFESSIONAL SERVICES
Part 10 - HEALTH HOME SERVICES
Section 8.310.10.11 - PROVIDER RESPONSIBILITIES
Current through Register Vol. 35, No. 18, September 24, 2024
A. A provider agency who furnishes MAD services to an eligible recipient must comply with all federal and state laws, rules, regulations, and executive orders relevant to the provision of services as specified in the MAD PPA. A provider agency also must comply with all appropriate New Mexico administrative code (NMAC) rules, billing instructions, supplements, and policy, as updated. A provider agency is also responsible for following coding manual guidelines and centers for medicare and medicaid services (CMS) national correct coding initiatives (NCCI), including not improperly unbundling or upcoding services.
B. A provider agency must verify that a recipient is eligible for a specific health care program administered by HCA and its authorized agents, and must verify the recipient's enrollment status at the time services are furnished. A provider agency must determine if an eligible recipient has other health insurance and notify HCA. A provider agency must maintain records that are sufficient to fully disclose the extent and nature of the services provided to an eligible recipient.
C. When services are billed to and paid by a MAD fee-for-service (FFS) coordinated services contractor authorized by HCA, under an administrative services contract, the provider agency must also enroll as a provider with the coordinated services contractor and follow that contractor's instructions for billing and for authorization of services; see 8.302.1 NMAC.
D. The provider agency must:
E. For the provider agency that renders physical health and behavioral health services, additional staff may be included; see CareLink NM policy manual for detailed descriptions.