As you are aware, all Providers are required to use New Mexico Behavioral Health Collaborative Non-Medicaid funding only as a payor of last resort, as established at Article 3(K) of the Client Services Treatment Agreement. Many of the Clients served by the Non-Medicaid provider network will be Medicaid enrolled or eligible or may have other health insurance coverage. In order to comply with these requirements, each Provider must carefully project the need for funding of clinical services and assure that Medicaid funds or other coverage is used first and is maximized for each Client. It is incumbent upon the Provider to check Medicaid enrollment & eligibility
to billing for any Collaborative funding for services that are also covered by Medicaid.
In order to verify and ensure that all Providers have been complying with these requirements, the Collaborative Member Agencies, BHSD & CYFD, are conducting retroactive reviews of Non-Medicaid claims submitted to Falling Colors for payment to the Non-Medicaid Provider Network. These reviews will contain analysis of clients and services eligible for payment by other funding sources, such as Medicaid. 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.