N.M. Admin. Code § 8.326.7.17

Current through Register Vol. 35, No. 21, November 5, 2024

Section 8.326.7.17 - REIMBURSEMENT

A. 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. Once enrolled, instructions on documentation, billing and claims processing are sent to the medicaid providers. Reimbursement for case management providers is made at the lesser of the following:

(1) the provider's billed charge; or

(2) the MAD fee schedule for the specific service.

B. The provider's billed charge must be its usual and customary charge for the services.

C. "Usual and customary charge" refers to the amount which an individual provider charges the general public in the majority of cases for a specific procedure or service.

D. For case management services furnished by an institution, costs associated with case management must be removed from their cost reports prior to any cost settlement or rebasing.

N.M. Admin. Code § 8.326.7.17

1/31/96; 8.326.7.17 NMAC - Rn, 8 NMAC 4.MAD.776.8, 3/1/12