PRIOR AUTHORIZATION DATA CALL

STATE OF NEW MEXICO OFFICE OF SUPERINTENDENT OF INSURANCE SUPERINTENDENT OF INSURANCE Russell Toal 11. :i  51 OFACEOF NEW MEXICO SUPERINl,..DENT OF INSURANCE BULLETIN 2020-014 June 25, 2020 DEPUTY SUPERINTENDENT Robert E. Doucette, Jr. TO: ALL INSURANCE CARRIERS THAT OFFER HEALTH BENEFITS PLANS SUBJECT TO THE HEALTH INSURANCE PRIOR AUTHORIZATION ACT. RE: PRIOR AUTHORIZATION DATA CALL THE FOLLOWING BULLETIN is issued pursuant to Sections 59A-2-8 and 59A-2-10, NMSA 1978, and 13.1.2.1 to 13.1.2.10 NMAC. On April 4, 2019, Governor Michelle Lujan Grisham signed Senate Bill 188, the Health Insurance Prior Authorization Act ("the Act"). The Act has since been chaptered at Section 59A- 22B-4 NMSA 1978. The Act requires the Office of Superintendent of Insurance ("OSI") to collect and issue a report on each health insurer's use of prior authorization protocols by September 1, 2019, and each September 1 thereafter. Accordingly, all health insurers subject to the Health Insurance Prior Authorization Act shall submit the required data to OSI using the attached reporting form by 12:00 p.m. MST on August 3, 2020, to Rolanda Pana at rolanda.pana@state.mn.us. The fonn is also available in an editable fonnat on OSI's website https://www.osi.state.rnn.us/wp-content/uploads/2020/06/Prior­ Authorizations-Data-Call-Reporting-Template.xlsx. Insurers shall report data separately for fully-insured lines of business, Medicaid coverage, including fee for service coverage, and coverage provided under the Health Care Purchasing Act. Reporting for fully-insured lines of business shall be aggregated for all markets. Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110 Main Phone: (505) 827-4601 I Satellite Phone: (505) 322-21861 Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us B U I, L E T I N 2 0 2 0 - O I 4 P a g e 2 Any person aggrieved by a bulletin may request a liearing before the Superintendent in accordance with Section 59A-4-15, NMSA 1978. If you have questions regarding this bulletin, please contact Rolanda Pafia at (505) 322- 2186 orrolanda.pana@state.nrn.us. ISSUED this 25f'l day of June, 2020. SuperinXTL Insurance Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 100, Albuquerque, NM 87110 Main Phone: (505) 827-4601 i Satellite Phone: (505) 322-2186i Toll Free: (855) 4 - ASK - OSI www.osi.state.i'un.us Company name: Line of business: Contact name: Contact phone number: Contact email address: Prior Authorizations Report, 2019 Plan Year Prior authorization (PA) requests generally: Number Total number of PAs requested Total number of PAs denied Total number of PAs approved Total number of PAs unresolved or indefinitely pended Total number of PAs granted for which payment was retroactively denied PA requests for specified benefits: Prescription drug requests: Inpatient Outpatient Total number of PA requests for prescription drugs Number of PA requests for prescription drugs denied Number of PA requests for prescription drugs unresolved or indefinitely pended Mental health (MH) and substonce use disorder (SUD) tremment PA requestsi Number Total number of PA requests for MH and/or SUD benefits Number of PA requests for MH and/or SUD benefits denied Number of PA requests for MH and/or SUD benefits unresolved orindefinitely pended Processing time: 5 days 6-15 days 15-30 days 30 days + Number of decisions on nonurgent/nonemergent PA requests completed within.... 24 hours 25-48 hours 49-72 hours 72 hours + Number of decisions on urHent/emergent PA requests completed within.... PA approval/denial frequency: CPTcodes (induding modfliers, if applicable) and descriptors of the ten covered services for which PA /s most frequently DENIED CPT Code Descriptor CPTcodes (including modifiers, if applicable) and descriptors of the ten covered services for which PA is most frequentlyAPPROVED CPT Code Descriptor