N.M. Stat. § 59A-57A-13
Providers; reimbursement for a surprise bill.
A. For services provided pursuant to Section 3 [59A-57A-3 NMSA 1978] or 4 [59A-
57A-4 NMSA 1978] of the Surprise Billing Protection Act, a health insurance carrier
shall directly reimburse a nonparticipating provider for care rendered the surprise bill
reimbursement rate for services.
B. The surprise bill reimbursement rate shall be calculated using claims data
reflecting the allowed amounts paid for claims paid in the 2017 plan year.
C. As used in this section, "surprise bill reimbursement rate" means the sixtieth
percentile of the allowed commercial reimbursement rate for the particular health care
service performed by a provider in the same or similar specialty in the same geographic
area, as reported in a benchmarking database maintained by a nonprofit organization
specified by the superintendent after consultation with health care sector stakeholders;
provided that no surprise bill reimbursement rate shall be paid at less than one hundred
fifty percent of the 2017 medicare reimbursement rate for the applicable health care
service provided.
D. The nonprofit organization shall be conflict-free and unaffiliated with any
stakeholder in the health care sector.