The enactment of SB488 is expected to significantly impact the landscape of healthcare reimbursement in New Mexico. By establishing these timeframes, the bill aims to reduce the administrative burden on healthcare providers, who often face challenges related to unexpected reimbursement denials long after services have been rendered. This reform aligns with broader efforts to ensure fair practices within insurance coverage and to promote a stable working environment for providers.
Summary
Senate Bill 488 seeks to amend the New Mexico Insurance Code, Health Maintenance Organization Law, and Nonprofit Health Care Plan Law by limiting the retroactive denial of reimbursement to health care providers. Specifically, the bill stipulates that insurers can only retroactively deny claims if fewer than six months have elapsed since payment was made, or if the claim was under coordination of benefits and fewer than eighteen months have passed since initial payment. This provides clear timelines to enhance consistency and protect providers from unexpected claim denials.
Contention
Among the points of contention around SB488, there are concerns about safeguarding against fraudulent claims. Although the bill allows for exceptions in cases of fraud, improper coding, or duplicate submissions, the specific definitions and implications of these terms could lead to disputes. Some stakeholders worry that the rigidity of the timeframes may lead to healthcare providers inadvertently facing financial challenges if insurers do not adequately comply or interpret the regulations fairly.