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.

Guidance Chart

Provider Grievance Crosswalk and Guidance

Regulations

13.10.16 NMAC

Bulletins and News

Please check back frequently for updates

Provider Complaint Form

Download Insurance Health Care Provider Complaint Form

ORDER ESTABLISHING PARAMETERS FOR DEFRAYAL UNDER 13.10.41 NMAC, COVERAGE FOR SPECIFICED SEX TRAIT MODIFICATION PROCEDURE

Pursuant to NMSA, Section 59A-2-8 General powers and duties of superintendent, this order provides an initial interpretation of what specified sex trait modification procedures and prescriptions are eligible for defrayal starting Plan Year 2027 for health plans sold on the New Mexico BeWell Exchange. Office of Superintendent of Insurance (OSI) staff may revisit this interpretation […]

MEDICAL MALPRACTICE PREMIUM REDUCTION

BULLETIN 2026-010: The New Mexico State Legislature appropriated $5 million to the New Mexico Office of Superintendent of Insurance (OSI) to address medical malpractice insurance costs for individual providers. The appropriation was part of a supplemental appropriation package passed in 2025. This one-time appropriation directs OSI to provide a premium subsidy for private medical malpractice insurance policies. […]