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- All providers who receive DOH funding have been assigned a ValueOptions New Mexico funding stream designation that is to be utilized when submitting claims. This is to be designated in Box 11 of the HCFA 1500 or Box 61 of the UB92 forms.
These funding stream designations communicate the funding that you are using for the services being billed. The funding stream that you are designated to receive payment for is listed on the exhibit that you received that outlined your Agency funding.
As a reminder, the funds available are the following:
DOHO – General DOH funding
DOHI – Southern NM Inpatient Funding
DOHN – Native American designated funds
Most providers will use the DOHO funding designation. The DOHI funding is for a select group of providers that are located in the Southern part of the state that provide inpatient services only to the DOH population. DOHN is reserved for Native American Programs with special funding.
- All contracted ValueOptions New Mexico providers will be required to provide prompt written notification of critical incidents to VONM, as well as, submit other defined reports to state entities (listed in the State and Federal Notification Requirements in detail) no later than November 1, 2005.
Critical incidents are defined as “occurrences that represent actual or potential serious harm to the well being of a VONM consumer, or to others by a VONM consumer who is in active behavioral health treatment, or has been recently discharged (i.e. within the past 12 months) from behavioral health treatment."
It is the policy of ValueOptions New Mexico to thoroughly review and respond appropriately to all reported critical incidents. This includes investigation, follow-up, and tracking consistent with the circumstances of the event, consumer safety, and potential liability issues.
All contracted providers must be aware of critical incident definitions and the appropriate process of reporting a critical incident to VONM and pertinent state agencies. A VONM-specific document has been created, for use by the providers, to comply with this VONM reporting requirement. Coordination efforts were made with state regulatory agencies such as the Children, Youth and Families Department and the Department of Health to assist with the inclusion of necessary reporting elements in the VONM Critical Incident Report Form.
The process and necessary information for filing Critical Incidents include the following documents:
- VONM Critical Incident Report Form (1 Page)
- Instructions for VONM Critical Incident Reports (3 Pages)
- State and Federal Notification Requirements (2 Pages
The VONM Critical Incident Report Form, Instructions, and State and Federal Notification Requirements are located in the forms section of this website. Carefully review these documents and begin implementation of these procedures no later than November 1, 2005. If you have further questions or need clarification, please contact Debra Gonzales, Critical Incident Coordinator VONM at (505) 346 – 9485.
- The process for enrolling consumers in the VONM system has changed. The new process consists of separate procedures and forms for enrolling Medicaid-only recipients and those consumers who receive funding from sources other than or in addition to Medicaid (i.e. DOH, CYFD, etc.) These updated forms and instructions for their use are located in the FORMS section of this website under ‘Consumer Enrollment.’ With this change, providers need only supply information appropriate to the funding source for which they provide services.
- Training on claims and the new consumer enrollment system are taking place statewide. Please contact the Regional Office in your area for a schedule of training near you. The contact information for the Regional Offices can be obtained by clicking here. If you have further questions, please contact our Customer Service Line at 1-888-251-7511.
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