S 232 HEALTH INSURER PROVIDER INFO & REIMBURSEMENT

Sen Cliff R. Pirtle

Actions: [4] SHPAC/STBTC-SHPAC [8] DP/a-STBTC [12] DP - fl/a- PASSED/S (38-0) [15] HHHC-HHHC [18] DP - PASSED/H (65-0)

Scheduled: Not Scheduled

 Senate Bill 232 (SB 232) requires the superintendent of insurance to promulgate rules establishing a timeframe for insurers to load information on approved providers into their provider payment systems and requires insurers to reimburse approved providers if the insurers fail to load that information within thirty days of receiving a complete credentialing application. 

 Senate Bill 232 (SB 232) amends the following in the same manner:
•	Section 1 amends Section 59A-22-54 NMSA 1978
•	Section 2 amends Section 59A-23-14 NMSA 1978
•	Section 3 amends Section 59A-46-54 NMSA 1978
•	Section 4 amends Section 59A-47-49 NMSA 1978

The amendments make the following changes:
•	Changes the timeframe to assess and verify the qualifications of a provider applying to become a participating provider from forty-five to thirty calendar days.
•	States that no later than thirty days after the receipt of a complete credentialing application all information needed to correctly reimburse a newly approved provider must be loaded into the insurer’s provider payment system.
•	Changes the timeframe an insurer shall reimburse a provider for covered health care services from forty-five to thirty calendar days.
•	States that an insurer shall reimburse a provider for covered health care services for any claims from the provider that the insurer receives with a date of service more than thirty calendar days after the date on which the insurer received a complete credentialing application if certain pre-conditions apply.
•	Clarifies a pre-condition for the above rule.  The condition is that the insurer has approved, or has failed to approve or deny, the applicant’s complete credentialing application within the thirty day time frame; or if the insurer fails to load the approved applicant’s information into the insurers provider payment system within the thirty day time frame.
 

 SHPACa/SB 232: Senate Health and Public Affairs Committee amends Senate Bill 232:

•	Insert new paragraph between lines 6 and 7 on page 3 “Subsection F, Paragraph (2)”.  New language extends credentialing period.
•	Strike “(2)” (page 3, line 15)
•	Insert ”(3)” (page 3, line 15)
•	Strike “(3)” (page 4, line 2)
•	Insert ”(4)” (page 4, line 2)
•	Strike “days after receipt of a complete credentialing application” (page 3, lines 3 and 4)
•	Insert “calendar days as describes in Paragraph (1) of this subsection or an additional fifteen days as described in Paragraph (2) of this subsection” (page 3, lines 4 through 7)
•	Strike “(2)” (page 4, line 22)
•	Insert “(3)” (page 4, line 22)
•	Insert “or (2)” (page 5, line 17)
•	Strike “(3) (page 5, line 21)
•	Insert “(4)” (page 5, line 22)
•	Insert new paragraph between lines 6 and 7 on page 8 “Subsection F, Paragraph (2)”.  New language extends credentialing period.
•	Strike “(2)” (page 8, line 13)
•	Insert ”(3)” (page 8, line 13)
•	Strike “(3)” (page 9, line 2)
•	Insert ”(4)” (page 9, line 2)
•	Strike “days after receipt of a complete credentialing application” (page 9, lines 3 and 4)
•	Insert “calendar days as describes in Paragraph (1) of this subsection or an additional fifteen days as described in Paragraph (2) of this subsection” (page 9, lines 4 through 7)
•	Strike “(2)” (page 9, line 22)
•	Insert “(3)” (page 9, line 22)
•	Insert “or (2)” (page 10, line 17)
•	Strike “(3) (page 10, line 21)
•	Insert “(4)” (page 10, line 22)
•	Insert new paragraph between lines 6 and 7 on page 13 “Subsection F, Paragraph (2)”.  New language extends credentialing period.
•	Strike “(2)” (page 13, line 15)
•	Insert ”(3)” (page 13, line 15)
•	Strike “(3)” (page 14, line 2)
•	Insert ”(4)” (page 14, line 2)
•	Strike “days after receipt of a complete credentialing application” (page 15, lines 3 and 4)
•	Insert “calendar days as describes in Paragraph (1) of this subsection or an additional fifteen days as described in Paragraph (2) of this subsection” (page 15, lines 4 through 7)
•	Strike “(2)” (page 15, line 24)
•	Insert “(3)” (page 15, line 24)
•	Insert “or (2)” (page 16, line 17)
•	Strike “(3) (page 16, line 21)
•	Insert “(4)” (page 16, line 22)
•	Insert new paragraph between lines 25 and 26 on page 17 “Subsection F, Paragraph (2)”.  New language extends credentialing period.
•	Strike “(2)” (page 18, line 8)
•	Insert ”(3)” (page 18, line 8)
•	Strike “(3)” (page 18, line 21)
•	Insert ”(4)” (page 18, line 21)
•	Strike “days after receipt of a complete credentialing application” (page 18, lines 22 and 23)
•	Insert “calendar days as describes in Paragraph (1) of this subsection or an additional fifteen days as described in Paragraph (2) of this subsection” (page 18 line 23 through page 19 line 1)
•	Strike “(2)” (page 19, line 19)
•	Insert “(3)” (page 19, line 20)
•	Insert “or (2)” (page 20, line 12)
•	Strike “(3) (page 20, line 16)
•	Insert “(4)” (page 20, line 17)
 

 Senate Floor Amendment March 9, 2023 in STBTC

Fla/SB 232: This is an act relating to health insurance in the state of New Mexico. The act requires the superintendent of insurance to establish a time frame for insurers to load information on approved healthcare providers into their payment systems. If the insurers fail to load this information within 30 days of receiving a complete credentialing application, they must reimburse the approved providers for covered healthcare services for any claims received with a date of service more than 30 calendar days after the receipt of the complete credentialing application. The act also sets forth other requirements for the credentialing process, such as the frequency of primary credential verification and provisional credentialing, as well as the process for assessing and verifying the qualifications of a provider applying to become a participating provider.

The act specifies that the superintendent will establish rules to provide for a uniform and efficient provider credentialing process, with no more than two forms of application to be used for the credentialing of providers. The rules will require primary credential verification no more frequently than every three years and allow provisional credentialing for a period of one year.