On Apr. 7, 2025, NM LEG reported bill signed by governor and assigned Chapter 45.
On Mar. 21, NM LEG passed bill re loading dental credentialing records.
NM LEG passed bill HB 402 in order to establish a timeframe for information to be loaded into provider payment systems for approved dentists and dental hygienists.
Insurance carriers must reimburse approved dentists and dental hygienists if carriers fail to load that data within 30 days of receiving completed credentialing applications.
Adds new section to New Mexico statutes annotated 1978, NM INS 59A-23G-1 to -12.
Bill Provisions
New section requires adoption of uniform and efficient provider credentialing process.
Also approve application forms to use for credentialing of dentists/dental hygienists.
Carrier will not require dentist/dental hygienist to submit data that is not required.
Rules will require that primary credential verification will occur no more frequently than every three years and provisional credentialing will occur for a period of one year.
Insurance carriers must load data into payment systems for dentists/dental hygienists.
The carriers must reimburse approved dentists and dental hygienists if the carriers fail to load that data within 30 days of receiving completed credentialing applications.
The credentialing process may be extended if it is uncovered that there are sanctions, an investigation/felony conviction, revocation of clinical privileges or coverage denial.
Dentist/dental hygienist will be paid the contracted reimbursement rate if employed by a practice or group services, and if not, will be paid per standard reimbursement rate.
Legislative History
On Feb. 12, 2025, bill introduced in House; on Mar. 11, 2025, bill was passed in House.
On Mar. 12, 2025, bill delivered to Senate; on Mar. 21, 2025, bill passed in Senate.
Effectiveness
Bills without effective dates specified in bill text or emergency clauses become effective 90 days after adjournment of the Legislature, so effective on Jun. 20, 2025.
Apr. 2025 NM LEG Bill Approval
On Apr. 7, 2025, NM LEG reported bill signed by governor and assigned Chapter 45.
Regulators
NM LEG
Entity Types
Ins
Reference
Ch. 45, 4/7/2025; Bill HB402, 3/21/2025; Citation: NM INS 59A-23G;
Functions
Claims/Accelerated Benefits; Compliance; Financial; Legal; Record Retention
