A. Group coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act that offers a dental plan shall establish policies and procedures for payment recovery, including providing: (1) notice to the provider that identifies the error made in the processing or payment of the claim; (2) an explanation of the recovery being sought; and (3) an opportunity for the provider to appeal the recovery being sought as set forth in Subsection C of this section. B. Group coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act that offers a dental plan shall not initiate payment recovery procedures more than twenty-four months after the original payment for a claim was made unless the claim was fraudulent or intentionally misrepresented. C. Group coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act that offers a dental plan shall not attempt to recover an erroneously paid claim by withholding or reducing payment for a different claim unless the plan: (1) notifies the provider, in writing, within twelve months of the erroneously paid claim; and (2) advises the provider that an automatic deduction shall occur within forty-five days of receiving notification unless the provider submits a written appeal to the plan pursuant to the grievance rules prescribed by the superintendent of insurance. D. The provisions of this section shall not apply to duplicate payments. History: Laws 2023, ch. 169, § 3. Effective dates. — Laws 2023, ch. 169 contained no effective date provision, but, pursuant to N.M. Const., art. IV, § 23, was effective June 16, 2023, 90 days after adjournment of the legislature. Applicability. — Laws 2023, ch. 169, § 12 provided that the provisions of Laws 2023, ch. 169 apply to dental plans issued for delivery or renewed in this state on or after January 1, 2024.
‹ Prev All New Mexico sections Next ›
Lexace provides legal information, not legal advice, and no attorney–client relationship is created. Statute text is provided for general information and may not reflect the most recent amendments; verify against the official state code.