Our Mission Statement
To provide state-of-the-art professional Medicaid utilization review services in a timely, accurate, efficient and cost effective manner to our customers.
To detect and report quality of care concerns within the limits of our contracted authority and resources.
To detect and report fraud and abuse concerns within the limits of our contracted authority and resources.
To be or become an expert resource in these areas:
- Medicaid utilization review operations
- Utilization review data/information interpretation
- Clinical standards of practice
- Quality review operations
- Use of information technology in medical review
What We Do
- We perform reviews for a wide variety of services, including nursing home care, waiver services, durable medical equipment.
- We participate in provider training sessions.
- We offer customer service assistance.
- We participate in development of clinically-based criteria.
- We make recommendations to HSD/MAD for enhancements to programs
- We serve as a resource to providers throughout New Mexico.
