N.M. Admin. Code § 1.6.5.11

Current through Register Vol. 35, No. 21, November 5, 2024

Section 1.6.5.11 - COVERAGE DISPUTES

A. The director shall make a determination if the certificate applies to a presented claim. The decision of the director may only be appealed through arbitration, and such arbitration shall be requested by the covered party in writing to the director within 30 days of receipt of the written decision of the director.

B. If arbitration is requested, the covered entity and the director, on behalf of the fund shall, select one arbitrator within 15 days and submit the arbitrator's name in writing to the other side. Within 10 days after the selection of the two arbitrators, those two arbitrators shall select a third independent arbitrator. If the two sides cannot agree on the selection of the third arbitrator within those 10 days, either side may petition the First Judicial District Court in the county of Santa Fe for the appointment of the third arbitrator. The third arbitrator shall be an attorney and preside as the Chairperson of the arbitration panel. No arbitrator shall be employed or affiliated with the covered entity or the general services department, risk management division.

C. A decision of the panel shall be reported in writing to the director and to the covered entity. The written decision of the panel shall be given to both sides within thirty days of the close of the hearing.

D. All decisions of the arbitration panel shall be final and binding upon the parties and shall not be subject to any further appeal or court action.

N.M. Admin. Code § 1.6.5.11

1.6.5.11 NMAC - N, 7/1/2004