This bulletin is issued pursuant to NMSA 1978, Sections 59A-2-8, 59A-2-10, 59A-22B-1 through 59A-22B-8, the Prior Authorization Act, 13.12.2.1 to 13.1.2.10 NMAC, and 13.10.31.10 NMAC.

The Prior Authorization Act required the Office of Superintendent of Insurance (OSI or Superintendent) to issue a standardized prior authorization form by September 1, 2019, which shall be used by all health insurers and health care providers in the state for prior authorization requests beginning on January 1, 2020. Specifically, the Act states in NMSA 1978, Section 59A-22B-4(B):

On or before September 1, 2019, the office shall, in collaboration with health insurers and health care providers, promulgate a uniform prior authorization form for medical care, pharmaceutical benefits or related benefits to be used by every health insurer and health care provider after January 1, 2020; provided that the uniform prior authorization form shall conform to the requirements established for Medicare and Medicaid medical and pharmacy prior authorization requests.

Beginning January 1, 2020, the OSI began requiring all health insurers subject to the Act to accept only the attached New Mexico Uniform Prior Authorization Form from health care providers. Also, the OSI required that by January 1, 2021, all health insurers had to allow for the electronic submission of this form via an easily accessible, secure electronic portal.

PRIOR AUTHORIZATION FORM AND PROCESS FOR OBTAINING APPROVAL OF ALTERNATIVE PRIOR AUTHORIZATION REQUEST FORM