Effective July 1, 2009, Molina Healthcare of New Mexico, Inc. (Molina Healthcare) is now the contractor with the State of New Mexico Human Services Department/Medical Assistance Division (HSD/MAD) to serve as the Third Party Assessor (TPA). Molina Healthcare TPA is responsible for conducting Utilization Review (UR) for Medicaid Fee-For-Service (FFS) programs and assessment functions for certain home health, long-term care, and Home and Community-Based waiver services.
Medicaid FFS UR and TPA services were formerly contracted to Blue Cross Blue Shield of New Mexico (BCBSNM) and Lovelace Health Plan (LHP). Please take a few minutes to learn more about the outstanding services offered by Molina Healthcare TPA for these programs.
Level of Care (LOC) Determinations and Assessments