New Mexico Administrative Code
Title 8 - SOCIAL SERVICES
Chapter 350 - RECONSIDERATION OF UTILIZATION REVIEW
Part 3 - ABSTRACT SUBMISSION FOR LEVEL OF CARE DETERMINATIONS
Section 8.350.3.11 - SUBMITTING ABSTRACTS FOR RETROACTIVE PRIOR APPROVAL REVIEW
Universal Citation: 8 NM Admin Code 8.350.3.11
Current through Register Vol. 35, No. 18, September 24, 2024
A. To request retroactive prior approval review, a facility must submit the abstract, a request for retroactive prior approval review form and supporting documentation to the UR contractor. Facilities must provide at least the following supporting documentation:
(1) pertinent information,
such as physician orders, history and physical, physician progress notes or
hospital discharge summaries; all documentation must be date-stamped by the
facility verifying date of receipt from the physician or hospital.
(2) dated facility entries and records that
document telephone calls to physicians reminding them of the need to complete
the abstract, physician orders, history and physical or progress
notes;
(3) date-stamped copy of the
notification of medicaid eligibility; and
(4) documentation of other reasons for
delay.
B. Any request for retroactive prior approval review received without the required supporting documentation is returned to the facility.
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