New Mexico Administrative Code
Title 8 - SOCIAL SERVICES
Chapter 326 - CASE MANAGEMENT SERVICES
Part 8 - CASE MANAGEMENT SERVICES FOR CHILDREN PROVIDED BY JUVENILE PROBATION AND PAROLE OFFICERS
Section 8.326.8.17 - REIMBURSEMENT
Current through Register Vol. 35, No. 18, September 24, 2024
Case management providers must submit claims for reimbursement on the HCFA 1500 claim form or its successor. See 8.302.2 NMAC, Billing for Medicaid Services. Instructions on documentation, billing and claims processing are sent to approved medicaid providers.
A. Reimbursement for non-governmental providers: For community agencies, tribal government, or Indian health services, reimbursement for case management services is made at the lesser of the following:
B. The provider's billed charge must be the provider's usual and customary charge for services.
C. "Usual and customary charge" refers to the amount which the individual provider charges the general public in the majority of cases for a specific procedure or service.
D. Reimbursement for governmental providers: For case management services rendered by governmental agencies to the target population, reimbursement rates, rate setting methodology and reimbursement process will be delineated under the terms of the joint powers agreement between the government agencies and the human services department.
