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 § 13-7-43

Ch. 13Public Purchases and Property

Art. 7Health Care Purchasing

This text of New Mexico § 13-7-43 (Dental coverage; erroneously paid claims; restrictions on) is published on Counsel Stack Legal Research, covering New Mexico primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

N.M. Stat. Ann. § 13-7-43 (2026).

Text

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.