New Mexico § 13-7-43 Dental coverage; erroneously paid claims; restrictions on

New Mexico Statutes

§ 13-7-43 — Dental coverage; erroneously paid claims; restrictions on

New Mexico·Ch. 13 Public Purchases and Property·Art. 7 Health Care Purchasing

recovery. 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

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recovery. 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.

New Mexico § 13-7-43 (Dental coverage; erroneously paid claims; restrictions on) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.