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.

Agency Based Community Benefits (ABCB) Program

Agency Based Community Benefits (ABCB) Program Provider Enrollment FAQs

ABCB Initial Provider Enrollment Required Forms and Documents

TitleOpen File
ABCB Initial Application Checklist MAD 500AOpen File
Scope of Work Service Summary Form-MAD 501AOpen File
Statement of Financial Solvency MAD 502Open File
Attestation Form CMS Final Rule- MAD 615Open File
Quality Improvement Assurance-MAD 741Open File
ABCB Program Assurances- MAD 899Open File

ABCB Existing Provider Type 363 Required Forms and Documents to Add a Service

TitleOpen File
ABCB Application Checklist to ADD Services- MAD 500BOpen File
Scope of Work Service Summary Form - MAD 501AOpen File
Attestation Form - CMS Final Rule- MAD 615Open File