Client Services Bureau FAQs
- What is Salud!?
- How can I choose the managed care organization that is right for me?
- Once I choose an MCO, will I be able to change to another MCO?
- Can I change my MCO once I am locked in?
- If I am a Native American do I have to participate in managed care?
- Can I change my MCO primary care doctor?
- I don't have my Medicaid card and the doctor will not see me, what do I do?
- I need to see a specialist, what do I need to do?
- The MCO denied my request for service can I appeal the denial?
- I cannot find a doctor (dental, vision, etc.) in my area, how can I get care?
- If I have private insurance do I have to participate in managed care?
Salud! is the name for the New Mexico Medicaid managed care program. Medicaid clients in Salud! are enrolled with a managed care organization (MCO).
Ask your doctor which Medicaid MCO(s) they have selected. We recommend you contact each of the MCO(s) to find out which doctors are part of their network and the benefits provided by each MCO. The enrollment letter asking you to choose your MCO will include a phone number for each MCO.
You have until the 25th day of your third month in a Salud! MCO to change to another MCO. After your third month with the same MCO you will not be able to change for the next nine months. If you want to change MCOs during the nine months, you need to send us a letter that tells us why you want the change. We will let you know if you can change MCOs.
Clients who are locked in must submit a written request with supporting documentation to justify a change to another MCO. If your request to change MCO(s) is because you want to continue seeing your current physician, you must have your physician submit written documentation justifying why he/she must continue your care.
Native Americans are not enrolled in managed care unless requesting to be enrolled. Native Americans who are not enrolled in managed care receive their care through the regular fee for service Medicaid program.
Your managed care organization is the only one who can change your primary care doctor. You may contact the MCO member service unit for assistance in changing your doctor.
Your doctor’s office may verify eligibility by calling your MCO or the Department’s automated voice response system (AVRS).
You must request a referral to see a specialist from your MCO primary care physician. If you would like additional information you may contact your MCO’s member service unit.
You may file a complaint with your MCO or with the Medicaid office. If you have been denied a service or a service has been stopped or reduced you may file for a fair hearing by contacting the Department’s Fair Hearings Bureau.
You must contact the physician who requested the service and ask him to appeal to the MCO on your behalf. You may contact your MCO’s member service unit and request that they re-review your physician’s request for service.
You must contact your MCO’s member service unit and request their help in locating and possibly scheduling an appointment.
Yes. Your private insurance is primary to Medicaid. You must contact your MCO’s member service unit to let them know that you have private insurance and to learn how to coordinate your benefits.