State Law

New Mexico Statutes Ann-Chapter 59A-Article 57A. Surprise Billing Protection

07/20/2020 New Mexico Section 59A-57A-13

Providers; reimbursement for a surprise bill. (Repealed effective July 1, 2023.)

OON-Payment Issues

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.

Copyright © 2012-2020 New Mexico Compilation Commission. All rights reserved.