What are you looking for? Fraud AssessmentsCompany LicensingRenewalsStatutory DepositsFeesApplying for Admission & ApplicationsLife and Health DivisionProduct FilingPharmacy Benefit Managers (PBM) Reports, New Mexico Health Access Survey, and BriefsContracted and External ReportsOSI Health Insurance BriefsThe 2023 New Mexico Health Access SurveyResource BinderMiscellaneous Resource Binder ContentSmall Business Health Insurance Premium Relief InitiativePrescription Drug Price TransparencyMember GrievanceHealth Rate ReviewProvider GrievanceHealth Care Affordability FundRequest for Confidential StatusContinuous Quality ImprovementUtilization ManagementProvider CredentialingNetwork AdequacyManaged Health Care Compliance DeadlinesMental Health ParityDebt Collection Protection Act - Provider ResourceVaccine Purchasing ActGuidance for CarriersProperty & CasualtyFinancial RegulationAccredited ReinsurersFinancial StatementsFinancial Statements ArchiveFinancial Examinations Financial Examinations ArchiveFinancial and Market Conduct Examinations - ArchiveTitle Insurance Forms & TablesASR USR Schedules & InstructionsStatistical ReportsIndividuals and AgenciesContinuing Education (CE)Criminal OffenseLicense Status Verification OSI Events Calendar View our calendar of events Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization or step-therapy protocols that allow payers, particularly health insurance companies, to manage the cost of health care benefits by assessing its appropriateness before it is provided using evidence-based criteria or guidelines. OSI regulates the utilization management practices of health insurers. Filing Instructions – Updated Instructions Coming Soon Know your rights Endorsement Prior Authorization Flow Chart Reporting Templates Gold Card Reporting Guidance and Requirements – Updated July 12, 2023 Commercial Prior Authorization Data Call template – Updated September 2025 Medicaid Prior Authorization Data Call template Uniform Prior Authorization Form Click here to access the form. – Updated January 9, 2025 Prior Authorization Required Plan language STANDARD LANGUAGE, ADMINISTRATIVE DATA AND DISCONTINUATION NOTICES – NM OSI Rules 13.10.17, 13.10.22.9, 13.10.31 NMAC News, Bulletins, and Orders Bulletin 2025-001 – Request for Alternative Prior Authorization Form Bulletin 2022-011 – Prior Authorization Data Call Bulletin 2023-020 – Gold Carding Data Call Apply for TPA License NIPR Consumer Resources File a complaint about issues with prior authorization, step-therapy and drug formulary exceptions requests here Utilization Review Prior Authorization Data Calls and Reports 201820192020202120222023SummaryPrior Authorization Data Introduction Report (2019)Prior Authorization Report Introduction (2020)2023 Prior Authorization Executive Summary reportData ReportPrior Authorization Data Call Report (2018)Prior Authorization Data Call Report (2019)Prior Authorization Data Call Report (2020)Prior Authorization Data Call Report (2021)Coming soonIBAC-Insurer-Prior-Authorization-Report-Calendar-Year-2023Medicaid-Insurer-Prior-Authorization-Report-Calendar-Year-2023Commerical-Insurer-Prior-Authorization-Report-Calendar-Year-2023_All-Carriers
November 18, 2025 Bulletins 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 […] Read More
December 8, 2025 Announcements 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 […] Read More
November 17, 2025 News Releases 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 […] Read More
