Network Adequacy

OSI regulates insurers’ provider access for major medical health insurance plans. See details below on OSI’s provider access regulatory requirements.

Please download and review each document carefully. If a web preview distorts the formatting, downloading the file directly should correct the issue.

Provider Data Reporting Templates for QHPs only

Reports and News

Surprise Billing Press Release

Regulations

13.10.22.8 NMAC

Dental Network Adequacy

13.10.35 NMAC
Letter of self-attestation of compliance due Oct. 1st of each year

Surprise Billing

Surprise billing happens when people unknowingly get care from providers that are outside of their health plan’s network and can happen for both emergency and non-emergency care. OSI is responsible for the enforcement of New Mexico’s Surprise Billing Protection Act and portions of the federal No Surprises Act.

Know Your Rights Endorsement
Benchmark Organization Selection
Data Calls
- Bulletin 2025-003
- Surprise Billing Data Call template – Updated 05/2025
Reports (Coming Soon)
Air Ambulance
No Surprises Act (Coming Soon)
Rules – 13.10. 28 NMAC

Complaints

Members can file complaints about network adequacy here
Providers can file complaints about network adequacy here

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 are ongoing and apply to every insurer, adjuster, producer, and insurance professional conducting business within the State of New Mexico. […]

Network Adequacy

OSI Events Calendar

Network Adequacy – Existing Networks

Templates – Existing Networks

Workbooks – Existing Networks

Network Adequacy – New Networks