Provider Grievance

The Grievance Procedures, as outlined in 13.10.16.8 NMAC states a carrier shall adopt and implement a provider grievance plan that complies with this rule. This rule does not preclude a carrier and provider from addressing or resolving a concern through any other process agreed on between them, but no such alternative process shall preclude a provider from presenting a grievance through a process that complies with this rule.

OSI regulates member and provider grievances for major medical health insurance plans. See details below on OSI’s provider grievance regulatory requirements.

Guidance Chart

Provider Grievance Crosswalk and Guidance

Regulations

13.10.16 NMAC

Bulletins and News

Please check back frequently for updates

Provider Complaint Form

Download Insurance Health Care Provider Complaint Form

New Mexico Officials Demonstrate How Home Wildfire Mitigation Can Reduce Ignition Risk

Socorro, N.M. — The New Mexico Office of the Superintendent of Insurance (OSI) partnered with the Insurance Institute for Business & Home Safety (IBHS) and the State Fire Marshalls Dept. on October 7 to demonstrate how wildfire mitigation can affect a home’s vulnerability to fire. The demonstration compared model homes with different levels of wildfire […]

NEW MEXICO ANNOUNCES RATES FOR 2027 ACA PLANS, STATE PREMIUM SUPPORT WILL CONTINUE TO HELP ENROLLEES WITH COSTS

Contact: Life and Health Product Filing BureauEmail: life.health@osi.nm.gov SANTA FE, N.M. – The New Mexico Office of Superintendent of Insurance (OSI) has approved 2027 rates for individual market Affordable Care Act (ACA) plans sold on and off BeWell, the New Mexico Health Insurance Marketplace. The average increase is 24.4%; OSI scrutinized the rates and they […]