Current upload instructions: EFFECTIVE IMMEDIATELY

ALERT Until further notice, the PCF cannot admit any new providers. Additionally, the PCF cannot accept renewals of providers that were admitted into the PCF after July 28, 2017. Audits will be conducted of uploads received, and, if the upload contains any new providers or renewals from providers that were admitted into the PCF after July 28, 2017, the entire upload will be rejected and the check will be returned. Accordingly, until further notice, please only submit uploads that contain renewals of providers that were admitted into the PCF prior to July 28, 2017.

Carriers

 

Base Surcharges :: Experience Rating ::: ISO Classification Table :: Carriers Setup

  1. All insurance carriers that provide the primary layer of medical professional liability coverage for healthcare providers in the Patients’ Compensation Fund (PCF) must be licensed and admitted in New Mexico by the Office of Superintendent of Insurance or be a licensed risk retention group. Carriers must provide coverage on occurrence policies at limits prescribed by the New Mexico Medical Malpractice Act. Claims-made policies are not permitted.

  2. Admitted carriers and risk retention groups that want to become primary layer carriers in the PCF must apply for approval by:

    • Submitting a copy of the occurrence policy form(s) that they will be using, including the SERFF filing number(s) showing prior approval of those forms and rates, to Anna Krylova at anna.krylova@state.nm.us;

    • Agreeing to continue to provide legal defense through settlement for claims that enter the excess PCF layer of coverage

  3. The rates and forms used for the primary layer of medical professional liability coverage are subject to prior approval.

  4. ISO physician/surgeon specialty codes must be used. The mapping of those ISO codes to PCF rating classes is provided in this website.

  5. Carriers must submit coverage reports (i.e. renewals, cancellations and new coverages) to the PCF no later than 45 calendar days after the inception of the coverages or cancellations. Coverage reports must be accompanied by the remittance of their related surcharges.

  6. Carriers must upload coverage reports via http://pcfupload.osi.state.nm.us/FileUploadScreen.aspx, which uploads one physician at a time, or else via a mass upload. For instructions on performing a mass upload, contact our PCF Support Team, at OSI-PCF-Support@state.nm.us.

  7. Medically licensed business entities must use PCF class 51 if comprised of physicians or surgeons, class 52 if comprised of podiatrists and class 53 if comprised of chiropractors.

 

TABLE OF BASE SURCHARGES

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(Prior to the Application of Experience Rating Debits)
Effective October 1, 2017

PCF

  Base Surcharge for

Class

  Full-Time Health Care Providers

1

 

$2,920.00

2

 

$3,889.00

3

 

$4,676.00

4A

 

$5,843.00

4

 

$7,008.00

5A

 

$6,214.00

5

 

$8,562.00

6

 

$10,122.00

7A

 

$11,678.00

7

 

$15,569.00

8

 

$18,494.00

9A

 

$18,876.00

9

 

$22,384.00

10

 

$24,334.00

51

Doctor Business Entity

 

Single physician or surgeon

$341.00

Each additional doctor

$86.00

Each additional CRNA or PA

$42.00

52

 

Podiatrist Business Entity

 

Single podiatrist

$341.00

Each additional podiatrist

$86.00

Each additional CRNA or PA

$42.00
53  

Chiropractor Business Entity

 
 

Single chiropractor

$234.00

 

Each additional chiropractors

$54.00

99

  Chiropractor

$2,325.00

CRNA

 Certified Registered Nurse Anesthetist

$774.00

PA-1

Physician's Assistant - Supervised by Non-Invasive Specialists  

$1,319.00

PA-2

Physician's Assistant - Supervised by Specialists Performing Minor Surgery  

$1,760.00

PA-3

Physician's Assistant - Supervised by Specialists Performing Major Surgery  

$2,119.00

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*PCF follows the same underwriting carrier’s rules for Part-time providers. 

 

RULES FOR EXPERIENCE – RATING BASE SURCHARGES

Effective June 1, 2004

 

Carriers must debit the base surcharge of each physician or other healthcare provider according to his or her claim experience as described below and include the resulting debit in the total surcharge remitted to the PCF.

    Number of Claims Reported
    During the Last Five Years
    Debit
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    1 25%
    2 50%
    3 75%
    4 or more
    100%
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 Include only those claims which resulted in at least one of the following conditions:

  • A finding of both negligence and injury by the PCF medical review commission
  • A claim settlement requiring payment by the carrier or the
  • A trial judgment in favor of the plaintiff

* Do not report as a claim any incident that is overturned or dismissed with no monetary exchange.

Carriers are responsible for maintaining a repository of claim information in sufficient detail for them to calculate accurate debits. This may require carriers to expand their policy application questionnaires and procedures for obtaining information on claims incurred under prior carriers or in other states.

 

 

Classification Table Eff 2016
      ISO Class Code

    PCF
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    Specialty M.D. D.O. Class
    Abdominal Surgery 80166   9
    Acupuncture - Other than Acupuncture Anesthesia 80437 84437 1
    Aerospace Medicine / Medical Director 80230   1
    Allergy/Immunology - No Surgery 80254 84254 1
    Anesthesiology 80151 84151 7A
    Anesthesiology - All Other 80183 84183 7A
    Anesthesiology - Critical Care Medicine 80181 84181 7A
    Anesthesiology - Pain Management 80182 84182 2
    Angiography / Arteriography / Catheterization 80422 84422 4
    Broncho-Esophagology 80101   3
    Cardiac Surgery 80141   6
    Cardiovascular Disease - Minor Surgery 80281 84281 4
    Cardiovascular Disease - No Surgery 80255 84255 2
    Cardiovascular Disease - No Surgery 80225   2
    Cardiovascular Disease Surgery 80150 84150 10
    Chiropractors 80410   99
    Chiropractors - Corporate or Partnership Liability 80412   53
    Colon and Rectal Surgery 80115   9
    Colonoscopy / Endoscopic Retrograde Cholangiopancreatography/ Pneumatic or Mechanical Esophageal Dilation 80443 84443 3
    Cryosurgery 80429 84429 4
    Dermatology - All Other 80297 84297 3
    Dermatology - Clinical and Dermatological Immunology 80295 84295 3
    Dermatology - Dermatopathology 80296 84296 3
    Dermatology - including X-Ray Therapy / Radiation Therapy 80282   3
    Dermatology - No Surgery 80256 84256 2
    Diabetes - Minor Surgery 80271   3
    Diabetes - No Surgery 80237   1
    Discograms / Myleography / Pneumoencephalography 80428 84428 2
    Emergency Medicine - Including Major Surgery 80157 84157 6
    Emergency Medicine - No Major Surgery 80102 84102 5
    Endocrinology - Minor Surgery 80272 84272 3
    Endocrinology - No Surgery 80238 84238 1
    Endocrinology Surgery 80103   9
    General Practitioners or Family Physicians - Minor Surgery - No Ob 80421 84421 3
    General Practitioners or Family Physicians - No Surgery - No Ob 80420 84420 1
    Family Practitioners - No Ob/ No Surgery 80239   1
    Forensic Medicine / Legal Medicine 80240 84240 1
    Gastroenterology - Minor Surgery 80274 84274 4A
    Gastroenterology - No Surgery 80241 84241 3
    Gastroenterology Surgery 80104   9
    General Practitioners or Family Physicians - Minor Surgery - No Ob 80421 84421 3
    General Practitioners or Family Physicians - No Surgery - No Ob 80420 84420 1
    General Practitioners or Family Physicians - Ob but No Major Surgery  - performing 40 or less non-high risk deliveries yearly 80273   5A
    General Practitioners or Family Physicians - Ob but No Major Surgery  - performing high-risk deliveries or more than 40 deliveries yearly 80275   5
    General Practice or Family Practice Surgery 80117   9
    General Practitioners - No Ob/ No Major Surgery 80242   1
    General Preventive Medicine - No Surgery / No Ob 80231   1
    General Surgery 80143 84143 9
    General/Family Practitioners - No Major Surgery - < 40 Non-High-Risk Deliveries Yearly 80273   5A
    General/Family Practitioners - No Major Surgery - High-Risk or > 40 Deliveries Yearly 80275   5
    Geriatrics - Minor Surgery 80276 84276 3
    Geriatrics - No Surgery 80243 84243 1
    Geriatrics Surgery 80105   9
    Gynecology - Minor Surgery (including 1st trimester abortions) 80277 84277 3
    Gynecology - No Surgery 80244 84244 1
    Gynecology Surgery 80167 84167 8
    Hand Surgery 80169   6
    Head and Neck Surgery 80170   6
    Hematology - Minor Surgery 80278 84278 3
    Hematology - No Surgery 80245 84245 1
    Hospitalism 80222 84222 2
    Hypnosis 80232   1
    Infectious Diseases - Minor Surgery 80279   3
    Infectious Diseases - No Surgery 80246   1
    Intensive Care Medicine 80283 84283 3
    Internal Medicine - Minor Surgery 80284 84284 4
    Internal Medicine - No Surgery 80257 84257 2
    Laparoscopy (Peritonescopy) 80440 84440 2
    Laryngology Surgery 80106   6
    Larynogology - Minor Surgery 80285   3
    Larynogology - No Surgery 80258   1
    Lymphangiography / Phlebography 80434 84434 4A
    Manipulator   84801 1
    Needle Biopsy 80446 84446 2
    Neonatal/Perinatal Medicine 80804 84804 5
    Neoplastic Diseases - Minor Surgery 80286   3
    Neoplastic Diseases - No Surgery 80259   1
    Neoplastic Surgery 80107   6
    Nephrology - Including Child - Minor Surgery 80288 84288 6
    Nephrology - Minor Surgery 80287   4
    Nephrology - No Surgery 80260   3
    Nephrology Surgery 80108   6
    Neurology - Including Child - No Surgery 80261   2
    Neurology - Including Child - No Surgery - All Other 80299 84299 2
    Neurology - Including Child - No Surgery - Pain Management 80298 84298 2
    Neurology Surgery - Including Child 80152 84152 10
    Nuclear Medicine - Excluding Radiation Therapy 80262 84262 1
    Nurse Anesthetists     CRNA
    Nutrition 80248   1
    Obstetrics Surgery  (c-sections only) 80168   6
    Obstetrics Surgery / Gynecology Surgery 80153 84153 10
    Occupational Medicine 80233   1
    Oncology - Minor Surgery 80301 84301 5
    Oncology - No Surgery 80302 84302 2
    Oncology Surgery 80164 84164 8
    Ophthamology - Minor Surgery 80289 84289 2
    Ophthamology - No Surgery 80263 84263 1
    Ophthamology Surgery 80114   3
    Orthopedic Surgery 80154 84154 9
    Otology - Minor Surgery 80290   3
    Otology - No Surgery 80264   1
    Otology Surgery 80158   6
    Otorhinolaryngology - Minor Surgery 80291 84291 2
    Otorhinolaryngology - No Surgery 80265 84265 1
    Otorhinolaryngology Surgery 80159   6
    Pathology - All Other 80307 84307 1
    Pathology - Blood Banking/Transfusion Medicine - Minor Surgery 80303 84303 3
    Pathology - Blood Banking/Transfusion Medicine - No Surgery 80304 84304 1
    Pathology - Cytopathology - Minor Surgery 80305 84305 3
    Pathology - Cytopathology - No Surgery 80306 84306 1
    Pathology - Minor Surgery 80292   3
    Pathology - No Surgery 80266   1
    Pediatric Surgery 80180 84180 8
    Pediatrics - Minor Surgery 80293 84293 6
    Pediatrics - No Surgery 80267 84267 4A
    Pharmacology - Clinical 80234   1
    Physical Medicine and Rehabilitation - All Other 80209 84209 1
    Physical Medicine and Rehabilitation - Pain Management 80208 84208 2
    Physical Medicine and Rehabilitation / Physiatry 80235   1
    Physicians - Minor Surgery - No Ob 80294   3
    Physicians - No Surgery / No Ob - Urgent Care Only 80268 84268 3
    Physicians and Surgeons - Corporate or Partnership Liability 80999 84999 51
    Physicians Assistants - Supervised by Non-Invasive Specialists 80116 84116 PA-1
    Physicians Assistants - Supervised by Specialists Performing Major Surgery as Primary Surgeons 80116 84116 PA-3
    Plastic Surgery 80156 84156 8
    Plastic-otorhino-laryngology Surgery 80155 84155 8
    Podiatrists - Surgery 80993-S   7
    Podiatrists/Chiropodists - Corporate or Partnership Liability 80943   52
    Podiatrists/Chiropodists - No Surgery 80993-N   5
    Preventive Medicine - No Surgery - Aerospace Medicine 80133 84133 1
    Preventive Medicine - No Surgery - Medical Toxicology 80138 84138 1
    Preventive Medicine - No Surgery - Occupational Medicine 80134 84134 1
    Preventive Medicine - No Surgery - Public/General Health Medicine 80135 84135 1
    Preventive Medicine - No Surgery - Undersea/Hyperbaric Medicine 80139 84139 1
    Psychiatry - Addiction Psychiatry 80224 84224 1
    Psychiatry - All Other 80229 84229 1
    Psychiatry - Child and Adolescent Psychiatry 80226 84226 1
    Psychiatry - Forensic Psychiatry 80227 84227 1
    Psychiatry - Geriatric Psychiatry 80228 84228 1
    Psychiatry - Including Child 80249 84249 1
    Psychoanalysis 80250   1
    Psychosomatic Medicine 80251 84251 1
    Public Health 80236   1
    Pulmonary Diseases - No Surgery 80269 84269 2
    Radiation Therapy - by Employed Physicians or Surgeons Involved with Major Surgery 80163 84163 1
    Radiation Therapy - by Insured Physicians or Surgeons Involved with Major Surgery 80165 84165 1
    Radiation Therapy / Lasers - Used in Therapy 80425 84425 5
    Radiology - Diagnostic - Minor Surgery 80280 84280 5
    Radiology - Diagnostic - No Surgery 80253 84253 2
    Radiology - Interventional 80360 84360 5
    Radiology - Therapeutic - Minor Surgery 80358 84358 5
    Radiology - Therapeutic - No Surgery 80359 84359 2
    Radiopaque Dye Injections 80449 84449 4
    Rheumatology - No Surgery 80252 84252 1
    Rhinology - Minor Surgery 80270   3
    Rhinology - No Surgery 80247   1
    Rhinology Surgery 80160   6
    Sclerotherapy   84802 3
    Shock Therapy 80431 84431 1
    Shock Therapy  - by Employed Physicians or Surgeons Involved with Major Surgery 80161 84161 1
    Shock Therapy - by Insured Physicians or Surgeons Involved with Major Surgery 80162 84162 1
    Sports Medicine - Minor Surgery 80204 84204 4A
    Sports Medicine - No Surgery 80205 84205 2
    Teaching Physicians - Minor Surgery 80322   2
    Teaching Physicians - No Surgery 80321   1
    Teaching Physicians or Surgeons - Major Surgery 80323   7A
    Teaching Physicians or Surgeons - Major Surgery 80324   7A
    Teaching Physicians or Surgeons - Major Surgery 80325   7A
    Teaching Physicians or Surgeons - Major Surgery 80326   7A
    Teaching Physicians or Surgeons - Major Surgery 80327   7A
    Thoracic Surgery 80144 84144 9
    Traumatic Surgery 80171   9
    Urgent Care - No Surgery - No Ob 80268 84268 3
    Urological Surgery 80145 84145 6
    Urology - Minor Surgery 80120 84120 3
    Urology - No Surgery 80121 84121 1
    Vascular Surgery

    80146

      9
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