Section 27-11-11 – Costs of expedited adjudicatory proceeding.
A. Each party shall be responsible for its own costs related to the expedited adjudicatory proceeding, including costs associated with preparation for the hearing, discovery, depositions, subpoenas, service of process and witness expenses, travel expenses and investigation expenses and attorney fees. B. The hearing officer shall allow telephonic testimony of a witness if requested by […]
Section 27-11-12 – Rights of medicaid provider or subcontractor; preliminary or final determination of overpayment.
A. A medicaid provider or subcontractor may challenge: (1) the department’s preliminary or final determination of overpayment as: (a) exceeding statutory authority; (b) arbitrary or capricious; (c) a failure to follow department procedure; or (d) not supported by substantial evidence; (2) the credentials of persons who participated in the audit or claims review; or (3) […]
Section 27-11-13 – Release of suspended payment for services previously rendered; prepayment review; remedial training and education; temporary assistance.
A. The department shall direct the release of a suspended payment to a medicaid provider or subcontractor that is the subject of a referral based upon a determination of a credible allegation of fraud for services previously rendered if the medicaid provider or subcontractor posts a surety bond in the amount of the suspended payment, […]
Section 27-11-14 – Maintenance of services; payment for ongoing services.
A. Following the referral of a medicaid provider or subcontractor based on a determination of a credible allegation of fraud, and during the pendency of a dispute between the department and a medicaid provider or subcontractor regarding an alleged overpayment, including an overpayment based in whole or in part on a credible allegation of fraud, […]
Section 27-11-2 – Definitions.
As used in the Medicaid Provider and Managed Care Act: A. “claim” means a request for payment for services; B. “clean claim” means a claim for reimbursement that: (1) contains substantially all the required data elements necessary for accurate adjudication of the claim without the need for additional information from the medicaid provider or subcontractor; […]
Section 27-11-3 – Review of medicaid provider or managed care organization; contract remedies; penalties.
A. Consistent with the terms of any contract between the department and a medicaid provider or managed care organization, the secretary shall have the right to be afforded access to such of the medicaid provider’s or managed care organization’s records and personnel, as well as its subcontracts and that subcontractor’s records and personnel, as may […]
Section 27-11-4 – Retention and production of records.
A. Medicaid providers, managed care organizations and their subcontractors shall retain, for a period of at least six years from the date of creation, all medical and business records that are necessary to verify the: (1) treatment or care of any recipient for which the medicaid provider, managed care organization or subcontractor received payment from […]
Section 27-11-1 – Short title.
Chapter 27, Article 11 NMSA 1978 may be cited as the “Medicaid Provider and Managed Care Act”. History: Laws 1998, ch. 30, § 1; 2019, ch. 215, § 1. ANNOTATIONS The 2019 amendment, effective January 1, 2020, changed “This act” to “Chapter 27, Article 11 NMSA 1978”, and after “Medicaid Provider”, added “and Managed Care”. […]