New Mexico Administrative Code
Title 8 - SOCIAL SERVICES
Chapter 310 - HEALTH CARE PROFESSIONAL SERVICES
Part 9 - RURAL HEALTH CLINIC SERVICES
Section 8.310.9.16 - REIMBURSEMENT
Current through Register Vol. 35, No. 18, September 24, 2024
Rural health clinics must submit claims for reimbursement on the UB-92 claim form or its successor. See 8.302.2 NMAC, Billing for Medicaid Services. Once enrolled, providers receive instructions on documentation, billing, and claims processing.
A. Reimbursement for non-hospital based rural health clinics: Interim reimbursement is made at an encounter rate established for the clinic by the medicare intermediary.
B. Reimbursement for non-core services: Reimbursement to rural health clinics for drug services, dental services, vision services, hearing services, psychiatric or psychological services, and other non-core medical services is made according to the regulations applicable to each of these specific program areas. These services are not reimbursed on a reasonable cost basis, but instead are reimbursed as described in the applicable service sections.
C. Reimbursement for hospital based rural health clinics: Interim reimbursement to hospital, or other facility, based rural health clinics is made at the percentage determined by MAD. Adjustments and fiscal year reconciliations are made by MAD.