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:

Turquoise Care Managed Care Policy Manual Effective July 1, 2024

Section 01 - General Provisions-Final

Section 02 - Provider Networks -Final

Section 03 - Member Education-Final

Section 04 - Care Coordination-Final

Section 05 - Transitions of Care-Final

Section 06 - Nursing Facilities-Final

Section 07 - Community Benefits-Final

Section 08 - Agency Based Community Benefits-Final

Section 09 - Self Directed Community Benefits-Final

Section 10 - Reserved-Final

Section 11 - Marketing-Final

Section 12 - Patient Centered Initiatives-Final

Section 13 - Alternative Benefit Packages-Final

Section 14 - School Based Health Centers-Final

Section 15 - ITU-Final

Section 16 - Fair Hearings-Final

Section 17 - Managed Care Reporting-Final

Section 18 - Quality-Final

Section 19 - Program Integrity-Final

Section 20 - Pharmacy-Final

Section 21 - Manual Acronyms-Final

Centennial Care Managed Care Policy Manual Effective October 1, 2020

Centennial Care Managed Care Policy Manual Effective January 1, 2019

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

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