New Mexico Administrative Code
Title 8 - SOCIAL SERVICES
Chapter 320 - EARLY AND PERIODIC SCREENING, DIAGNOSIS AND TREATMENT (EPSDT) SERVICES
Part 6 - SCHOOL-BASED SERVICES FOR MAP ELIGIBLE RECIPIENTS UNDER TWENTY-ONE YEARS OF AGE
Section 8.320.6.18 - REIMBURSEMENT

Reimbursement to the LEA, REC, or SFEA is not contingent upon billing a third party payer first when the MAP eligible recipient has other insurance. MAD is generally the payer of last resort. However, if medical services are included in the MAP eligible recipient's IEP or IFSP, and an exception is created under 42 USE 1396b(c), 20 USC 1412(a)(12) and 34 CFR 300.142., and the services are otherwise covered by MAD, then MAD is authorized to pay for such services. The LEA, REC, or other SFEA must submit claims for reimbursement on the 837P electronic format or its successor unless it received written permission from MAD to bill on paper. Reimbursement to the LEA, REC or other SFEA for covered services billed by individual practitioners is made at the MAD fee schedule for the specific service.