As noted previously, in Provider Alerts dated October 13, 2017 and November 16, 2017, 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, BHSD & CYFD, 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 recouping those claims found to be eligible for payment by other funding sources, such as Medicaid,
beginning January 15, 2018.
Starting January 15, 2018 Falling Colors will begin reducing claims invoice payments by the amount found by the Member Agencies to be billable to Medicaid. This may lead to a reduced payment or non-payment by Falling Colors, as direct by the Member Agencies, until the total recoupment amount is satisfied. Medicaid will be providing a letter of direction to the MCO’s to allow providers to resubmit claims that were Medicaid eligible.