Provider Grievance

The Grievance Procedures, as outlined in 13.10.16.8 NMAC states a carrier shall adopt and implement a provider grievance plan that complies with this rule. This rule does not preclude a carrier and provider from addressing or resolving a concern through any other process agreed on between them, but no such alternative process shall preclude a provider from presenting a grievance through a process that complies with this rule.

OSI regulates member and provider grievances for major medical health insurance plans. See details below on OSI’s provider grievance regulatory requirements.

“OSI is currently working on updating the guidance and documents for these submissions. Please continue to check for updates, as OSI plans to have the materials re-posted by the end of the year to give carriers time to prepare prior to the March 1, 2026 submission deadline.”

Guidance Chart

Updated Guidance Chart Coming Soon!

Regulations

13.10.16 NMAC

Bulletins and News

Please check back frequently for updates

Provider Complaint Form

Download Insurance Health Care Provider Complaint Form

CLARIFICATION ON COORDINATION OF BENEFITS (COB) PROVISIONS FOR MINOR CHILDREN

BULLETIN 2025-015: This bulletin is issued in accordance with Sections 59-2-8, 59A-2-10, 59A-16-11(B) and 59A-46-31 NMSA 1978, and 13.1.2 and 13.10.13.11(B)(2) NMAC. The purpose of this bulletin is to clarify the position of the Office of Superintendent of Insurance (OSI) regarding allowable coordination of benefits provisions for a dependent child covered under more than one health insurance […]

Mandatory Reporting Requirements Under the New Mexico Insurance Fraud Act

NOTICE TO ALL LICENSEES, INSURERS, AND INSURANCE PROFESSIONALS Subject: Mandatory Reporting Requirements Under the New Mexico Insurance Fraud Act This notice serves as an official reminder that all insurers and licensed insurance professionals are required to comply with the mandatory reporting and cooperation requirements established under the New Mexico Insurance Fraud Act. These obligations […]

NEW MEXICO OFFICE OF THE SUPERINTENDENT OF INSURANCE HOSTS TOWN HALL IN SILVER CITY ON WILDFIRE PREPAREDNESS, MITIGATION AND INSURANCE RESOURCES

Contact: Elouisa Macias, Consumer Assistance Bureau ChiefEmail: Elouisa.Macias@osi.nm.gov Santa Fe, NM – On Wednesday, the Office of the Superintendent of Insurance (OSI) hosted a town hall in Silver City, NM related to wildfire preparedness and insurance resources. The town hall was moderated by Elouisa Macias, Consumer Assistance Bureau Chief, Civil Investigations Bureau at OSI. The […]