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Medicaid/CHIP Data Requirements in New Mexico

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        The law requires Medicaid providers to retain all medical and business records for at least 6 years.1  For example, Medicaid providers must maintain records relating to the medical necessity of services provided as well as treatment or services that were paid for by Medicaid.2  Medicaid recipients are entitled to access information regarding the expiration of their benefits by the filing of a request with the state.3  Filing a false Medicaid claim or trying to defraud the system is against the law and can result in monetary damages.4

        All state agencies that administer Medicaid programs are required to maintain the confidentiality of recipient’s application and benefits information.5  However, providers may be required to release confidential medical information to state and federal agencies in certain circumstances.6

 

Footnotes

  • 1. N.M.S.A. §27-11-4
  • 2. N.M.S.A. §27-11-4; N.M. Admin. Code 8.302.1
  • 3. N.M.S.A. §27-2-7.1
  • 4. N.M.S.A. §27-14-4
  • 5. N.M. Admin. Code 8.100.100.13
  • 6. N.M. Admin. Code 8.302.1

 

Medicaid/CHIP Data Requirements in New Mexico

Subtopic Statute/Regulation Description
Medicaid/CHIP Data Requirements Access to linking database-N.M. Code R. § 7.1.20.13 State and federal agencies may link their databases to the relevant databases within the HIS, but only to the extent that the data linked is relevant...
Failure to retain records; defined; penalties-N.M. Stat. Ann. § 30-44-5 All providers receiving Medicaid payments for the treatment of patients must maintain medical records, including the treatment or care of patients...
General Program Description – Medicaid-N.M. Code R. § 8.100.100.11(E) Generally, New Mexico’s Medicaid program is administered through Salud!, the Department’s Medicaid managed care program. Individual...
N.M. Admin. Code 8.302.1.17 Recordkeeping and Documentation Requirements Providers participating in Medicaid must maintain records to fully disclose the nature, amount, and...
Confidentiality of Medicaid data (including penalties for violating confidentiality) Confidentiality of Applicant/Recipient Information – N.M. Code R. §8.300.11.10 Protection of the confidentiality of information includes methods of receiving, maintaining, and communicating individually identifiable patient...
Confidentiality of Electronic Data – N.M. Code R. §8.300.11.11B Providers who send or receive confidential medical information through fax, must have a fax line dedicated to that sole purpose.  Providers who...
Confidentiality – N.M. Code R. §8.100.100.13 New Mexico regulations specify that state agencies that administer programs under the Social Security Act or the Food Stamp program maintain the...
Confidentiality – N.M. Code R. §8.300.11.9 The Human Service Department must keep the following information confidential: Name, address, social security number; Medical services...
Patient Confidentiality – N.M. Code R. §8.302.1.18 All providers participating in Medicaid must comply with HIPAA.  Additionally, providers are required to release confidential medical...
Access to Medicaid data (by patients, providers, and government agencies) Eligible Person Entitled to Information – N.M. Stat. Ann. §27-2-7.1 A recipient of public assistance is entitled to information regarding the expiration of Medicaid or other benefits if the recipient or his/her...
Medicaid medical records maintenance by providers (including retention period, storage, and other recordkeeping requirements) Retention and production of records – N.M. Stat. Ann. §27-11-4 New Mexico requires Medicaid providers to retain all medical and business records for at least 6 years.  The relevant records that must be...
Click on the individual state law in the table above to see our summary of the individual law.


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