MedicaidPrior AuthHigh impact
Supplement 26-06: State of New Mexico Handicapping Labio-lingual Deviation (NM HLD) Index Report Form – MAD 908
New Mexico Medicaid·NM · Dentistry·Medical Policy
Effective date
Oct 1, 2026
We identified it
Sep 12, 2026
Summary
New Mexico Medicaid requires providers to submit prior authorization requests for comprehensive orthodontic treatment using the standardized MAD 908 form (HLD Index Report Form) beginning October 1, 2026. Requests submitted without this form will be rejected and must be resubmitted, potentially resulting in claim denials.
Action Required
By October 1, 2026: Billing team must implement the following changes: (1) Update billing software and prior authorization workflows to require the MAD 908 form for all comprehensive orthodontic treatment requests for New Mexico Medicaid recipients under 21 years old; (2) Obtain and implement the MAD 908 form template from the Comagine Health website (https://comagine.org/program/new-mexico-medicaid/providers); (3) Train all staff submitting prior authorizations to use ONLY the MAD 908 form when submitting to Comagine Health (the TPA for FFS recipients); (4) Update provider templates and checklists to reference the MAD 908 requirement. For MCO-enrolled recipients, coordinate with the specific MCO regarding their submission process. For technical assistance, contact Comagine Health at 1-866-962-2180 or madinfo.hca@hca.nm.gov. Failure to submit prior authorizations using the MAD 908 form will result in request rejection and claim denials.