FILING LIMIT EXTENSIONS FOR COVID-19 RELATED CLAIMS

STATE OF NEW MEXICO OFFICE OF SUPERINTENDENT OF INSURANCE SUPERINTENDENT OF INSURANCE Russell Toal .11. @51 omc.tor MEW MEXO '""'"''fNOENT Of IN5URANCf BULLETIN 2021-005 March 31, 2021 DEPUTY SUPERINTENDENT Jennifer A. Catechis TO: ALL INSURERS LICENSED TO SELL HEAL TH INSURANCE IN NEW MEXIC:O RE: FILING LIMIT EXTENSIONS FOR COVID-19 RELATED CLAIMS The New Mexico Office of Superintendent of Insurance ("OSI") is concerned that some health care insurers may be denying providers' claims for COVID-19 related services based on late submission. As we all know, conditions created by the public health emergency ("PHE"), e.g., high demand for services, remote work for staff, provider reassignment and inaccurate or missing insurance coverage infonnation at the time of service, all contributed to a high likelihood that some billings for COVID-19 related services will be or were delayed and may not be submitted within a payer's standard filing limit for original claims. The purpose of this Bulletin is to ensure that all providers, including the New Mexico Depa1iment of Health, are allowed sufficient time for the submission of claims for COVID-19 services. The OSI directs eve1y health insurer licensed in New Mexico to allow every emolled network provider one full calendar year from the date of service to file a claim for any COVID-19 related testing, vaccination or treatment if the date of service occurs during the PHE, which began on March 12, 2020. Insurers are fu1iher directed to reprocess any COVID-19 claim previously denied as untimely. This extension of the filing limit is in line with the New Mexico Human Services Department's recent Letter of Direction to its Medicaid Managed Care Organizations that extended the Medicaid filing limit to one full calendar year for COVID-19-related services. In addition, the one full calendar year filing limit is Medicare's standard filing limit. Therefore, the OSI believes Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110 Main Phone: (505) 827-4601 I Satellite Phone: (505) 322-2186 I Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us BULLETIN 2021-005 Pagei2 this requirement is reasonable and will advance New Mexico's effoits to combat COVID-19 and protect the health of our communities and our essential providers. Thank you for your cooperation during this challenging time. ISSUED this 31st day of March, 2021. ffis'gbi,u6ht Superintendent of Insurance Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110 Main Phone: (505) 827-4601 i Satellite Phone: (505) 322-2186i Toll Free: (855) 4 - ASK - OSI www.osi.state.tun.us