Medicaid UR Review Types

Blue Cross and Blue Shield of New Mexico (BCBSNM), serving as the Medicaid Utilization Review contractor, works within time frames required by the Medical Assistance Division (MAD). These time frames are based on the BCBSNM contract with MAD and/or the regulations as stated in the MAD Program Policy Manual.

For more information about a review type, select from the list below:

• Technical Denial Process (PDF 29K)
• Contact Lens
• Dental Services
• Durable Medical Equipment
• Emergency Alien Services
• Hearing Aids
• High-volume, High-dollar Procedures, Surgical
• Home and Community-Based Waivers (medically fragile, disabled and elderly, AIDS and AIDS-related complex, developmental disabilities)
• Home Health Care
• Inpatient Rehabilitation Hospital
• In-state Transplant
• Intermediate Care Facilities for the Mentally Retarded
• Nursing Facility
• Nursing Facility – PACE
• Nursing Facility – PASRR
• Out-of-state Medical
• Out-of-state Transplant
• Outpatient Rehabilitation Services (occupational, physical, speech therapies)
• Pre-Transfer
• Private Duty Nursing

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