New Mexico § 27-11-12 Rights of medicaid provider or subcontractor; preliminary

New Mexico Statutes

§ 27-11-12 — Rights of medicaid provider or subcontractor; preliminary

New Mexico·Ch. 27 Public Assistance·Art. 11 Medicaid Providers

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) 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.

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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) 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.

New Mexico § 27-11-12 (Rights of medicaid provider or subcontractor; preliminary) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.