{"data":{"id":"us-nm/59a-23g-12","jurisdiction":"us-nm","citation":"59A-23G-12","heading":"Dental plan; provider network leasing.","body":"A. For purposes of this section:\n(1) \"contracting entity\" means any person or entity that enters into direct contracts with a provider for the delivery of services in the ordinary course of business;\n(2) \"provider\" means a person acting within the scope of licensure to provide dental services or supplies;\n(3) \"provider network contract\" means a contract between a contracting entity and a provider specifying the rights and responsibilities of the contracting entity and providing for the delivery of and payment for services to covered persons; and\n(4) \"third party\" means a person or entity that enters into a contract with a contracting entity or with another third party to gain access to the services or contractual discounts of a provider network contract.\nB. At a time when a contract relevant to granting access to a provider network to a third party is entered into or renewed, or when there are material modifications made, a contracting entity shall not require a provider to participate in third-party access to the provider network contract or contract directly with a third party that acquired the provider network. If a provider opts out, the contracting entity shall not cancel or otherwise end a contractual relationship with the provider. When initially contracting with a provider, a contracting entity must accept a qualified provider even if the provider rejects a network lease provision.\nC. A contracting entity shall not grant a third party access to a provider network contract, a provider's services or discounts provided pursuant to a provider network contract unless:\n(1) the provider network contract states that the contracting entity may enter into an agreement with a third party, allowing the third party to obtain the health insurance carrier's rights and responsibilities as though the third party were the contracting entity;\n(2) the third party accessing the provider network contract agrees to comply with all of the terms of the provider network contract; and\n(3) the contracting entity:\n(a) identifies all third parties with which it contracts in a list on its website that is updated every ninety days;\n(b) notifies a provider that a new third party is planning to lease or purchase the provider network contract at least thirty business days before the lease or purchase takes effect;\n(c) requires the third party to identify the source of the discount on all remittances or explanation of benefits under which the discount is taken; and\n(d) makes available a copy of the provider network contract relied upon in the adjudication of a claim to a provider within thirty days of the provider's request.\nD. A third party's right to a provider's discounted rate shall cease upon the termination date of the provider network contract.\nE. The provisions of this section shall not apply if access to a provider network contract is granted to a dental carrier of an entity operating in accordance with the same brand licensee program as the contracting entity or to an entity that is an affiliate of the contracting entity. A list of the contracting entity's affiliates shall be made available to a provider on the contracting entity's website.","path":["Chapter 59A - Insurance Code","ARTICLE 23G Short-Term Health Plan and Excepted Benefit"],"source_url":"https://nmonesource.com/nmos/nmsa-unanno/en/item/18562/index.do","current_through":"2026-07-01","vintage":"","retrieved_at":"2026-09-03T15:02:20Z","sha256":"0671fac069b8a5a892f950b862e39ad51da1aa2b2688ce4ef56e7e984b1198ca","source_id":"us-nm","stale":false,"prev":"us-nm/59a-23g-11","next":"us-nm/59a-23g-13"},"notice":"GroundRules: Original legal text. Not legal advice."}