New Mexico Administrative Code
Title 8 - SOCIAL SERVICES
Chapter 310 - HEALTH CARE PROFESSIONAL SERVICES
Part 12 - INDIAN HEALTH SERVICE AND TRIBAL 638 FACILITIES
Section 8.310.12.11 - PROVIDER RESPONSIBILITIES AND REQUIREMENTS

A. A provider who furnishes services to an eligible recipient must comply with all applicable laws, regulations, rules, standards, and the provisions of the MAD PPA. A provider must adhere to MAD program rules as specified in the New Mexico administrative code (NMAC) and program policies that include, but are not limited to, supplements, billing instructions, and utilization review directions, as updated. The provider is responsible for following coding manual guidelines and centers for medicare and medicaid services (CMS) correct coding initiatives, including not improperly unbundling or upcoding services.

B. A provider must verify an individual is eligible for a specific MAD service and verify the recipient's enrollment status at time of service. A provider must determine if an eligible recipient has other applicable health insurance. A provider must maintain records that are sufficient to fully disclose the extent and nature of the services provided to an eligible recipient.

C. Services furnished must be within the scope of practice defined by the provider's licensing board, scope of practice act or regulatory authority, or as customarily provided under IHS or public health service administrative direction including the level of supervision required for services.