What are you looking for? License Status VerificationAnnual/Quarterly ChecklistsFraud AssessmentsCompany LicensingApplying for Admission & ApplicationsRenewalsStatutory DepositsFeesLife 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 BinderConsumer Assistance Plan Continuous Quality ImprovementCoverage for Individuals with Diabetes (HB53)Cultural and Linguistic PlanDebt Collection Protection Act - Provider ResourceDental Provider CredentialingGuidance for CarriersHealth Rate ReviewManaged Health Care Compliance DeadlinesMember GrievanceMental Health ParityMonthly Member EnrollmentNetwork AdequacyPrescription Drug Price TransparencyProvider CredentialingProvider GrievanceRequest for Confidential StatusSmall Business Health Insurance Premium Relief InitiativeUtilization ManagementVaccine Purchasing ActProperty & 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 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
August 11, 2026 Announcements ORDER ESTABLISHING PARAMETERS FOR DEFRAYAL UNDER 13.10.41 NMAC, COVERAGE FOR SPECIFICED SEX TRAIT MODIFICATION PROCEDURE Pursuant to NMSA, Section 59A-2-8 General powers and duties of superintendent, this order provides an initial interpretation of what specified sex trait modification procedures and prescriptions are eligible for defrayal starting Plan Year 2027 for health plans sold on the New Mexico BeWell Exchange. Office of Superintendent of Insurance (OSI) staff may revisit this interpretation […] Read More
June 22, 2026 Bulletins MEDICAL MALPRACTICE PREMIUM REDUCTION 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
