{"data":{"id":"us-nm/13-7-43","jurisdiction":"us-nm","citation":"13-7-43","heading":"Dental coverage; erroneously paid claims; restrictions on recovery.","body":"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:\n(1) notice to the provider that identifies the error made in the processing or payment of the claim;\n(2) an explanation of the recovery being sought; and\n(3) an opportunity for the provider to appeal the recovery being sought as set forth in Subsection C of this section.\nB. 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.\nC. 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:\n(1) notifies the provider, in writing, within twelve months of the erroneously paid claim; and\n(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.\nD. The provisions of this section shall not apply to duplicate payments.","path":["Chapter 13 - Public Purchases and Property","ARTICLE 7 Health Care Purchasing"],"source_url":"https://nmonesource.com/nmos/nmsa-unanno/en/item/18513/index.do","current_through":"2026-07-01","vintage":"","retrieved_at":"2026-09-03T15:02:19Z","sha256":"bdeb5e5163aa68d0f539a38179b778c8fcb0f20d83173c00ef284e808cdbfba9","source_id":"us-nm","stale":false,"prev":"us-nm/13-7-42","next":"us-nm/13-7-44"},"notice":"GroundRules: Original legal text. Not legal advice."}