MedicaidPrior AuthMedium impact
Supplement 23-03: Suspension of Prior Authorization Requirements for Skilled Nursing, Long-Term Care, and Home Health Facilities/Agencies Replaces Supplement 22-12
New Mexico Medicaid·NM·Prior Authorization
Effective date
Apr 17, 2023
We identified it
Jun 21, 2026
Summary
New Mexico has suspended all prior authorization requirements for transfers from acute care facilities to skilled nursing, long-term care, and home health facilities during a public health emergency. Providers must still verify Medicaid eligibility and follow specific claim submission procedures, including using disaster relief condition codes.
Action Required
Immediately: For New Mexico Medicaid patients transferred from acute care facilities - (1) Verify Medicaid eligibility before admission using NM Web Portal, MEVS, or AVRS systems. (2) For skilled nursing/long-term care: Email required patient information to NM.Providers@hsd.nm.gov with subject 'Acute Care Facility Transfer to Nursing Facility' before submitting claims, use revenue code 0190 for room and board, and enter condition code DR in UB04 boxes 18-28. (3) For home health: Email required information with subject 'Acute Care Facility to Home Health' and verify PA is in place before claim submission. (4) Use condition code DR for tracking on all claims. Failure to follow these steps will result in claim denials.