N.M. Code R. § 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.
[7/1/94; Recompiled 11/30/01]