PROVIDERS

The Health Care Authority’s mission is: We ensure that New Mexicans attain their highest level of health by providing whole-person, cost-effective, accessible, and high-quality health care and safety-net services.

Managed Care Policy Manual

The purpose for the Managed Care Policy Manual is to provide a reference for the policies established by HCA for the administration of the Medicaid managed care program and to provide direction to the Managed Care Organizations (MCOs) and other entities providing service under managed care.

Click on the link to view:

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Turquoise Care Managed Care Policy Manual Effective July 1, 2024

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Section 01 - General Provisions-Final

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Section 02 - Provider Networks -Final

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Section 03 - Member Education-Final

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Section 04 - Care Coordination-Final

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Section 05 - Transitions of Care-Final

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Section 06 - Nursing Facilities-Final

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Section 07 - Community Benefits-Final

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Section 08 - Agency Based Community Benefits-Final

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Section 09 - Self Directed Community Benefits-Final

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Section 10 - Reserved-Final

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Section 11 - Marketing-Final

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Section 12 - Patient Centered Initiatives-Final

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Section 13 - Alternative Benefit Packages-Final

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Section 14 - School Based Health Centers-Final

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Section 15 - ITU-Final

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Section 16 - Fair Hearings-Final

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Section 17 - Managed Care Reporting-Final

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Section 18 - Quality-Final

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Section 19 - Program Integrity-Final

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Section 20 - Pharmacy-Final

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Section 21 - Manual Acronyms-Final

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Centennial Care Managed Care Policy Manual Effective October 1, 2020

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Centennial Care Managed Care Policy Manual Effective January 1, 2019

For Agency Based Community Benefits Program (ABCB) documents and forms, click here.