New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 324 - ADJUNCT SERVICES › Part 7 - TRANSPORTATION SERVICES AND LODGING › Section 8.324.7.10 - ELIGIBLE PROVIDERS

Current through Register Vol. 35, No. 13, July 16, 2024
Health care to a MAP eligible recipient is furnished by a
				  variety of providers and provider groups. Reimbursement and billing for these
				  services are administered by MAD. Upon approval of a New Mexico MAD provider
				  participation agreement (PPA) by MAD or its designee, licensed practitioners,
				  facilities and other providers of services that meet applicable requirements
				  are eligible to be reimbursed for furnishing covered services to a MAP eligible
				  recipient. Providers must be enrolled before submitting a claim for payment to
				  the MAD claims processing contractors. MAD makes available on the HSD/MAD
				  website, on other program specific websites, and in hard copy format,
				  information necessary to participate in health care programs administered by
				  HSD or its authorized agents, including program rules, billing instructions,
				  utilization review (UR) instructions, and other pertinent material. When
				  enrolled, a provider receives instruction on how to access these documents. It
				  is the provider's responsibility to access these instructions, to understand
				  the information provided and to comply with the requirements. Providers must
				  contact HSD, or its authorized agents, for answers to billing questions or any
				  of these materials. To be eligible for reimbursement, a provider must adhere to
				  the provisions of the MAD PPA and applicable statutes, regulations, rules, and
				  executive orders. MAD or its selected claims processing contractor issues
				  payments to a provider using electronic funds transfer (EFT) only. Providers
				  must supply necessary information in order for payment to be made. The
				  following providers are eligible to be reimbursed for providing transportation
				  or transportation related services to MAP eligible recipients:
A. air ambulances certified by the state of
				New Mexico department of health (DOH), emergency medical services
				bureau;
B. ground ambulance
				services certified by the New Mexico public regulation commission (NMPRC) or by
				the appropriate state licensing body for out-of-state ground ambulance
				services, within those geographic regions in the state specifically authorized
				by the NMPRC;
C. non-emergency
				transportation vendors (taxicab, vans and other vehicles) and certain bus
				services certified by the NMPRC, within those geographic regions in the state
				specifically authorized by the NMPRC;
D. long distance common carriers, that
				include buses, trains and airplanes;
E. certain carriers exempted or warranted by
				the NMPRC within those geographic regions in the state specifically authorized
				by the NMPRC;
F. lodging and meal
				providers; and
G. when services are
				billed to and paid by a MAD MAP coordinated services contractor authorized by
				HSD, under an administrative services contract, the provider must also enroll
				as a provider with the coordinated services contractor and follow that
				contractor's instructions for billing and for authorization of
				services.