N.M. Admin. Code § 13.10.12.10

Current through Register Vol. 35, No. 23, December 10, 2024

Section 13.10.12.10 - REQUIREMENTS FOR USE OF J512 FORM

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.

N.M. Admin. Code § 13.10.12.10

7/1/94; Recompiled 11/30/01