N.M. Stat. § 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; 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.