Medicaid provides for services furnished by border providers and out-of-state providers in instances when the needed services are not available in the state of New Mexico or when recipients are traveling out-of-state and need medical attention. Prior approval is required for all out-of-state services.
To be reimbursed for nonemergency medical services, prior authorization must be obtained from Molina Healthcare TPA. Providers must complete the New Mexico Medical Assistance Program Provider Participation Application and have the application approved by HSD/MAD. Providers will receive a letter of notification from Molina Healthcare TPA containing information on approved services and billing instructions. This letter is necessary for billing to the fiscal agent.