As noted previously, in Provider Alerts dated October 13, 2017, November 16, 2017, and January 9, 2018, all Providers are required to use New Mexico Behavioral Health Collaborative Non-Medicaid funding only as a payor of last resort, as established in Article 3(K) of the Client Services Agreement. In the event claims paid by Falling Colors are found by the Member Agencies to be eligible for payment by other funding sources, such as Medicaid, those claims will be subject to the overpayment process, outlined in Article 32 of the Client Services Agreement.
The Collaborative Member Agencies have conducted retroactive reviews of Non-Medicaid claims submitted to Falling Colors for payment to the Non-Medicaid Provider Network in FY18. The Collaborative has directed Falling Colors to begin the recoupment process for those claims found to be eligible for payment by other funding sources, such as Medicaid,
beginning March 19, 2018.
On March 19
, Medicaid will be providing a letter of direction to the MCO’s to allow providers to resubmit claims that were Medicaid eligible. For a description of the methodology used by BHSD for identifying claims for recoupment, please review the Medicaid Recoupment document posted here in the Claims Processing Section:
Falling Colors will hold a training on the BHSDStar QA Review Module that will be used by the Collaborative and Providers for recoupment this
Thursday March 22, 2018 at 12pm
in the Falling Colors Large Conference Room located at 125 Lincoln Ave. Suite #223 Santa Fe, NM 87501.
Falling Colors will need each claims provider to submit the designated staff member(s) they wish to have access to the BHSDStar QA Review Module to
by March 23, 2018.
For those unable to attend in person, registration for the Webinar is below:
The purpose of this meeting is to review and receive training on the new QA Review/Recoupment functionality in BHSDSTAR, which is the mechanism for Providers and Member Agencies to negotiate the services in question. After registering, you will receive a confirmation email containing information about joining the webinar. The training will be recorded and posted afterwards on bhsdstar.org Training tab.
Below are the contacts for Medicaid members that are incarcerated for more than 30 days and placed in the Suspended Medicaid Category of Eligibility (054). The providers should be referred to MAD and can email the below contacts for resolution.