N.M. Admin. Code § 13.10.17.25 - INDEPENDENT CO-HEARING OFFICERS (ICOS)
A.
Identification of ICOs. The
superintendent shall provide for maintenance of a list of licensed
professionals qualified to serve as ICOs. The superintendent shall select
appropriate professional societies, organizations or associations to identify
licensed health care and other professionals who are willing to serve as ICOs
in external reviews who maintain independence and impartiality of the
process.
B.
Disclosure of
interests. Prior to accepting designation as an ICO, each potential ICO
shall provide to the superintendent a list identifying all health care insurers
and providers with whom the potential ICO maintains any health care related or
other professional business arrangements and briefly describe the nature of
each arrangement. Each potential ICO shall disclose to the superintendent any
other potential conflict of interest that may arise in hearing a particular
case, including any personal or professional relationship to the grievant, or
to the health care insurer, or providers involved in a particular external
review.
C.
Compensation of
ICOs.
(1)
Compensation
schedule. The superintendent shall determine reasonable compensation for
health care and other professionals who are appointed as ICOs for external
grievance reviews and shall annually publish a schedule of ICO compensation in
a bulletin.
(2)
Statement of
ICO compensation. Upon completion of an external review, the attorney
and co-hearing officers shall each complete a statement of ICO compensation
form prescribed by the superintendent; detailing the amount of time spent
participating in the external review, and submit it to the superintendent for
approval. The superintendent shall send the approved statement of ICO
compensation to the grievant's health care insurer.
(3)
Direct payment to ICOs.
Within 30 days of receipt of the statement of ICO compensation, the grievant's
health care insurer shall remit the approved compensation directly to the
ICO.
(4)
No compensation with
early settlement. If the parties provide written notice of a settlement
up to three days prior to the date set for external review hearing,
compensation will be unavailable to the hearing officers or ICOs.
D.
Record retention.
The hearing officer and ICOs must maintain written records for a period of
three years and make them available upon request to the state.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.