What are you looking for? License Status VerificationAnnual/Quarterly ChecklistsFraud 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 BinderRequest for Confidential StatusContinuous Quality ImprovementUtilization ManagementMember GrievanceHealth Rate ReviewProvider GrievanceMonthly Member EnrollmentHealth Care Affordability FundProvider CredentialingDental Provider CredentialingCoverage for Individuals with Diabetes (HB53)Network AdequacyManaged Health Care Compliance DeadlinesMental Health ParityDebt Collection Protection Act - Provider ResourceMiscellaneous Resource Binder ContentSmall Business Health Insurance Premium Relief InitiativePrescription Drug Price TransparencyVaccine Purchasing ActGuidance for CarriersProperty & CasualtyFinancial RegulationFinancial and Market Conduct Examinations - ArchiveAccredited ReinsurersFinancial StatementsFinancial Statements ArchiveFinancial Examinations Financial Examinations ArchiveTitle Insurance Forms & TablesASR USR Schedules & InstructionsStatistical ReportsIndividuals and AgenciesContinuing Education (CE)Criminal Offense 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)Prior Authorization Data Call Report (2022)IBAC-Insurer-Prior-Authorization-Report-Calendar-Year-2023Medicaid-Insurer-Prior-Authorization-Report-Calendar-Year-2023Commerical-Insurer-Prior-Authorization-Report-Calendar-Year-2023_All-Carriers
June 26, 2026 Bulletins 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. […] Read More
June 12, 2026 Announcements NOTICE OF PRESCRIPTION DRUG PRICE TRANSPARENCY ANNUAL MEETING The Office of the Superintendent of Insurance will hold its annual public meeting to present and discuss the findings and recommendations contained in the 2025 Prescription Drug Price Transparency legislative report. The purpose of this meeting is to inform the public of the report’s contents and to provide an opportunity for public comments and questions. […] Read More
