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

NEW MEXICO ANNOUNCES RATES FOR 2027 ACA PLANS, STATE PREMIUM SUPPORT WILL CONTINUE TO HELP ENROLLEES WITH COSTS

Contact: Life and Health Product Filing BureauEmail: life.health@osi.nm.gov SANTA FE, N.M. – The New Mexico Office of Superintendent of Insurance (OSI) has approved 2027 rates for individual market Affordable Care Act (ACA) plans sold on and off BeWell, the New Mexico Health Insurance Marketplace. The average increase is 24.4%; OSI scrutinized the rates and they […]

MEDICAL MALPRACTICE PREMIUM REDUCTION

AMENDED 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. […]