New Mexico § 27-2-23 - Third party liability

§ 27-2-23. Third party liability

A. The income support division of the department shall make reasonable efforts to

ascertain any legal liability of third parties who are or may be liable to pay all

or part of the medical cost of injury, disease or disability of an applicant for or

recipient of medical assistance pursuant to the provisions of Chapter 27 NMSA 1978 . B. When the department makes medical assistance payments on behalf of a recipient,

the department is subrogated to any right of the recipient against a third party for

recovery of medical expenses to the extent that the department has made payment. C. Health insurers, including self-insured plans, group health plans, service benefit

plans, managed care organizations, pharmacy benefit managers or other parties, that

are, by statute, contract or agreement, legally responsible for payment of a claim

for a health care item or service, as a condition of doing business with New Mexico,

shall: (1) provide, with respect to individuals who are eligible for or are provided medical

assistance under the medicaid program, upon the request of the state, information

to determine during what period the individual, the individual's spouse or the individual's

dependents may be, or may have been, covered by a health insurer and the nature of

the coverage provided by the health insurer, including the name, address and identifying

number of the plan; (2) accept New Mexico's right of recovery and the assignment to New Mexico of any

right of an individual or other entity to payment from the party for an item or service

for which payment has been made under the medicaid program; (3) respond to any inquiry by New Mexico regarding a claim for payment for any health

care item or service that is submitted no later than three years after the date of

the provision of such health care item or service; and (4) agree not to deny a claim submitted by New Mexico solely on the basis of the date

of submission of the claim by the provider, the type of the claim form or a failure

to present proper documentation at the point-of-sale that is the basis of the claim,

if: (a) the claim is submitted by New Mexico within the three-year period beginning on

the date on which the item or service was furnished; and (b) any action by New Mexico to enforce its rights with respect to such claim is commenced

within six years of New Mexico's submission of such claim. D. Nothing in this section shall be construed to preclude the application of common

law principles in determining equitable reimbursement from any third-party source

for New Mexico or a health insurer, including self-insured plans, group health plans,

service benefit plans, managed care organizations, pharmacy benefit managers or other

parties.