New Mexico Administrative Code
Title 8 - SOCIAL SERVICES
Chapter 350 - RECONSIDERATION OF UTILIZATION REVIEW
Part 3 - ABSTRACT SUBMISSION FOR LEVEL OF CARE DETERMINATIONS
Section 8.350.3.13 - PAYMENT FOLLOWING APPROVAL OF RETROACTIVE PRIOR APPROVAL REVIEW ABSTRACTS
Current through Register Vol. 35, No. 18, September 24, 2024
Medicaid reimburses facilities in the following manner after approval of a retroactive prior approval review:
A. for late initial abstracts caused by delayed physician signature, reimbursement is effective back to the date of admission;
B. for late initial abstracts caused by delayed medicaid eligibility decisions, reimbursement is effective back to the date the recipient became medicaid-eligible;
C. for late continued-stay abstracts caused by delays in obtaining physician signature or retroactive medicaid eligibility, reimbursement is effective from the beginning of the certification period for continued stay;
D. for the first ten (10) late abstracts per facility per calendar when delay is attributed to circumstances within the facility's control, reimbursement is effective back to the date of admission or the beginning of the certification period for continued stay applicable to the situation; and
E. for late abstracts beyond the ten (10) allowed by medicaid attributed to circumstances within the facility's control, the earliest possible effective date is the date the late abstract was received by the UR contractor.
