New Mexico Statutes 27-11-12. Rights of medicaid provider or subcontractor; preliminary or final determination of overpayment
Current as of: 2023 | Check for updates
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A. A medicaid provider or subcontractor may challenge:
Terms Used In New Mexico Statutes 27-11-12
- Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
(1) the department’s preliminary or final determination of overpayment as: (a) exceeding statutory authority;
(b) arbitrary or capricious;
(c) a failure to follow department procedure; or
(d) not supported by substantial evidence;
(2) the credentials of persons who participated in the audit or claims review;
or
(3) the methodology or accuracy of the department’s audit.
B. A medicaid provider or subcontractor may, but shall not be required to, conduct its own audit or sampling to challenge a preliminary or final determination of overpayment.