{
FALL 2016
| FOR MEMBERS OF NEW MEXICO HEALTH CONNECTIONS
}
OUR WEBSITE
Your source for complete
member information
W
e would like to remind you about
our website,
www.mynmhc.org .There are many helpful items
to read on our website. You can
view and/or download information about the fol-
lowing topics on the website.
•
Information about New Mexico Health Con-
nections’ (NMHC’s) Quality Improvement
Program, including goals, processes, and out-
comes as related to care and service.
•
Information about NMHC’s Case Manage-
ment Program and how you or your caregiver
may self-refer to the Program.
•
Information about NMHC’s Dis-
ease Management Programs and
how you may self-refer to the
Programs.
•
Information about how
to contact staff if you have
questions about how we
manage care and services
(utilization management,
UM) and the toll-free
number to call to contact
staff.
•
The availability of
TDD/TTY services.
•
NMHC’s policy
prohibiting financial
incentives for UM
decision-makers.
•
A description of
the availability of an
independent external
appeals process for
UM decisions made
by NMHC.
•
NMHC’s member
rights and responsibilities
statement.
•
Information about ben-
efits and services included in,
and excluded from, coverage.
•
Information about our pharmacy
procedures and coverage of drugs,
including copayments; NMHC’s
drug list, along with restrictions
and preferences; how to use our
pharmacy procedures; an explana-
tion of limits and quotas; how
to receive coverage for non-
formulary drugs and an expla-
nation of how practitioners can
provide information to support an exception;
and NMHC’s processes for generic substitution,
therapeutic interchange, and step-therapy.
•
Information about copayments and other
charges for which you are responsible.
•
Information about restrictions on benefits that
apply to services obtained outside NMHC’s
system or service area.
•
Information about how you may obtain language
assistance to talk with us about how we manage
care and services or to obtain information about
benefits, access to services and other issues.
•
Information about how you may submit a claim
for covered services, if applicable.
•
Information about how you may obtain in-
formation about network practitioners and
the professional qualifications of practitioners,
including specialty, medical school attended,
residency completed, and board certification
status.
•
How you may obtain primary care services, in-
cluding how to choose and access a primary care
practitioner.
•
How you may obtain specialty care and behav-
ioral health services and hospital services.
•
How you may obtain care after normal office
hours.
•
How you may obtain emergency care, includ-
ing NMHC’s policy on when to directly access
emergency care or use 911 services.
•
How you may obtain care and coverage when
you are out of NMHC’s service area.
•
How you may voice a complaint.
•
How you may appeal a decision that adversely af-
fects coverage, benefits or your relationship with
NMHC.
•
How NMHC evaluates new technology for
inclusion as a covered benefit.
There is other information about NMHC and
our services on the website that is useful to know.
Our physician and hospital directories allow you
to select a physician or hospital that best meets your
needs. You can search for a physician by specific
characteristics, such as gender or language spoken.
You can search for a hospital by location and name.
Our website also contains information and inter-
esting tools to help you better understand what you
can do to improve your health.
If you would like more information about
these items, please call Customer Service at
855-769-6642
. The most recent information
about NMHC, our services and coverage of drugs is
always available on our website.