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) the methodology or accuracy of the department's audit.
B. A medicaid provider or subcontractor may, but shall not be required to, conduct its own audit or sampling to challenge a preliminary or final determination of overpayment.
History: Laws 2019, ch. 215, § 10.
Effective dates. — Laws 2019, ch. 215, § 20 made Laws 2019, ch. 215 effective January 1, 2020.
Severability. — Laws 2019, ch. 215, § 19, provided that if any part or application of this act is held invalid, the remainder or its application to other situations or persons shall not be affected.
Structure New Mexico Statutes
Chapter 27 - Public Assistance
Article 11 - Medicaid Providers
Section 27-11-1 - Short title.
Section 27-11-2 - Definitions.
Section 27-11-4 - Retention and production of records.
Section 27-11-8 - Informal conference; corrective action; requirements.
Section 27-11-9 - Expedited adjudicatory proceedings; requirements.
Section 27-11-11 - Costs of expedited adjudicatory proceeding.
Section 27-11-14 - Maintenance of services; payment for ongoing services.
Section 27-11-15 - Disposition of recovered medicaid funds.
Section 27-11-16 - Credible allegation of fraud; judicial review; substantial evidence required.
Section 27-11-17 - Award of costs, fees and interest.
Section 27-11-18 - Applicability of Administrative Procedures Act.