New Mexico Administrative Code › Title 8 - SOCIAL SERVICES › Chapter 310 - HEALTH CARE PROFESSIONAL SERVICES › Part 3 - PROFESSIONAL PROVIDERS, SERVICES AND REIMBURSEMENT › Section 8.310.3.9 - ELIGIBLE PROVIDERS

Current through Register Vol. 35, No. 13, July 16, 2024
A. Health
				care to eligible medical assistance program (MAP) recipients is furnished by a
				variety of providers and provider groups. The reimbursement and billing for
				these services is administered by the HSD medical assistance division (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. A provider 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, or in hard copy format, information necessary to
				participate in health care programs administered by HSD or its authorized
				agents, including MAD New Mexico administrative code (NMAC) program rules,
				billing instructions, utilization review instructions, and other pertinent
				materials. 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. The provider must contact HSD or its authorized agents to obtain
				answers to questions related to the material. To be eligible for reimbursement,
				a provider must adhere to the provisions of their MAD PPA and all applicable
				statutes, regulations, and executive orders. MAD or its selected claims
				processing contractor issues payments to a provider using electronic funds
				transfer (EFT) only. Upon approval of the New Mexico medical assistance PPA by
				MAD, the following practitioners and facilities may be enrolled as MAD
				providers:
(1) medical practitioners:
(a) a physician licensed to practice medicine
				or osteopathy;
(b) a licensed
				certified nurse practitioner under the supervision or in collaboration with a
				physician or as an independent practitioner;
(c) a licensed physician assistant certified
				by the national commission on certification of physician assistants under the
				supervision of a physician;
(d) a
				licensed pharmacist clinician under the supervision of a physician;
(e) a licensed clinical nurse specialist
				under the supervision or in collaboration with a physician or as an independent
				practitioner;
(f) a licensed nurse
				anesthetist certified by the American association of nurse anesthetists council
				on certification of nurse anesthetists;
(g) a licensed anesthesiologist assistant
				certified by the national commission for certification of anesthesiologist
				assistants (NCCAA);
(h) a licensed
				podiatrist;
(i) a licensed and
				certified nurse midwife;
(j) a
				licensed midwife;
(k) a licensed
				dietician or a licensed nutritionist under the direction of a licensed
				physician;
(l) a licensed
				optometrist;
(m) a licensed
				audiologist certified by the American speech and hearing association;
(n) a licensed chiropractor; or
(o) a licensed naturopathic doctor;