New Mexico Administrative Code
Title 13 - INSURANCE
Chapter 10 - HEALTH INSURANCE
Part 12 - STANDARDIZED HEALTH CLAIM FORMS
Section 13.10.12.10 - REQUIREMENTS FOR USE OF J512 FORM
Universal Citation: 13 NM Admin Code 13.10.12.10
Current through Register Vol. 35, No. 18, September 24, 2024
A. Issuers shall accept the J512 form for claims for professional dental services.
B. Issuers may not require a dentist to use any code other than the CDT-1 codes for the initial filing of claims for dental care services, unless the use of supplemental codes are defined and permitted in a written contract between the issuer and dentist.
C. Dentists utilizing the J512 form for submission of claims for professional dental services shall:
(1) follow the instructions for the form
provided by the American dental association CDT - 1; and
(2) if billing patients directly, provide a
properly completed J512 form in addition to any other form used to bill the
patient when requested by the patient.
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