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

o 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. ANNOTATIONSEffective 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.