Managed Health Care Bureau

Managed Health Care Bureau

The Managed Health Care Bureau of Office of Superintendent of Insurance assists the Superintendent in administering and enforcing the New Mexico Insurance Code, Patient Protection Act and Office of Superintendent of Insurance rules related to commercial managed health care insurance in New Mexico. The Bureau’s key focus is to assist managed health care consumers and subscribers in understanding their rights to appeal matters such as, but not limited to; premium payments, termination of coverage, claims, and benefits denials, offered under a commercial managed health care plan in the State of New Mexico. Such appeals and complaints are rights afforded to every commercial managed health care subscriber under the New Mexico Patient Protection Act to include quality and access to care.

The Bureau also promotes the education of these rights by conducting outreach presentations throughout New Mexico. Our staff will come and deliver outreach presentation to your group.

Managed Health Care Bureau also assists health care providers with certain issues related to managed health care insurer operations and specifically, terminations, clean claim issues, and timely credentialing.

Billing Examples

Choosing a provider can impact the amount you pay…Continue Reading

Common Terms

Click here to read about more terms like Coinsurance, Co-Payment, Deductible…Continue Reading

External Review

New Mexico has two types of appeals processes…Continue Reading

Managed Health Care Bureau does not have jurisdiction over Medicaid, Medicare, and Self-Funded Group Plans.
For Medicare contact:

The Centers for Medicare and Medicaid (CMS)

7500 Security Boulevard Review

Baltimore, MD 21244-1850

https://www.medicare.gov/

1-800-Medicare (1-800-633-4227)

For Medicaid contact:

NM Human Services Department (Medicaid)

Medical Assistance Division

P.O. Box 2348

Santa Fe, NM 87504-2348

http://www.hsd.state.nm.us/Contact_Us.aspx

1-800-997-2583

For the US Department contact:

US Department of Labor (Self-Funded / ERISA)

200 Constitution Ave NW

Washington, DC 20210

http://www.dol.gov

1-866-487-2365

Annual Grievance Reports will be posted soon!
Tips
  • If a problem should arise your first step should be to contact your insurer.
  • Document verbal correspondence; get the name of the person providing you information, write down the main issues and the response and the date and time the conversation occurred.
  • Do not hesitate to ask your plan any questions especially, If something is the slightest bit confusing, unclear or you just don’t understand.
  • Review your Summary of Benefits and Coverage and Plan Booklet to better understand your appeal rights and timeframes.
  • If you are going to seek out of network care ask your plan what the reasonable and customary charges for the care you are going to receive and ask the provider the same question. (See an example of balanced billing)
  • Ask the cost of out of pocket expenses.
Contact Managed Health Care Bureau
Mailing Address

Office of Superintendent of Insurance
Managed Healthcare Bureau
PO Box 1689,
Santa Fe, NM 87504-1689
phone: 1-855-427-5674
Fax: 505-827-4734

Submit a direct query

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