PROVIDER CREDENTIALING REPORTING

STATE OF NEW MEXICO OFFICE OF SUPERINTENDENT OF INSURANCE SUPERINTENDENT OF INSURANCE Russell Toal DEPUTY SUPERINTENDENT Jennifer A. Catechis Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 400, Albuquerque, NM 87110 Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us BULLETIN 2022-024 December 28, 2022 TO: ALL FULLY-INSURED, MAJOR MEDICAL HEALTH INSURERS SUBJECT TO THE JURISDICTION OF THE NEW MEXICO SUPERINTENDENT OF INSURANCE (“SUPERINTENDENT”) RE: PROVIDER CREDENTIALING REPORTING Pursuant to 13.10.28.10(D) NMAC, “[e]ach health carrier shall submit a report to the superintendent regarding its credentialing process for the prior two-year period beginning December 31, 2018, and on December 31 for all even numbered years thereafter, or as otherwise directed by the superintendent.” The December 31st reporting deadline does not account for the time needed by insurers to collect data on credentialing during the last quarter of the reporting period. Accordingly, major medical insurers that offered coverage for sale in New Mexico in 2021 and 2022 shall furnish credentialing data to the Superintendent on May 1, 2023, and biennially each May 1, going forward. Reporting for the May 1, 2023 reporting deadline shall: 1. Include primary care practitioners, psychiatrists, other behavioral health providers, medical/surgical specialists, doctors of oriental medicine, and laboratory facilities credentialed by a major medical insurer. Reporting for one category of provider shall not overlap with reporting for any other category of provider. 2. Carriers shall report for any years they participated in New Mexico’s health insurance market during the 2021 through 2022 reporting period. Carriers that withdrew from the health insurance market shall continue to report for any period for which they have enrollment in their health insurance plans. 3. Dental insurers shall be excluded from this reporting cycle. B U L L E T I N 2 0 2 2 - 0 2 4 P a g e | 2 Main Office: 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 400, Albuquerque, NM 87110 Main Phone: (505) 827-4601 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us 4. A template for major medical insurance carriers’ report is included herewith as Appendix A. Carriers shall use the appropriate template. 5. Carriers shall file completed templates in SERFF with the appropriate filing fee and Filing Type “Informational,” TOI “Network Adequacy,” and Sub-TOI “Provider Credentialing Plan,” with public access allowed. 6. The filing shall be due by or on May 1, 2023. If you have questions regarding this Order, please contact Paige Duhamel, Life and Health Division, Office of Superintendent of Insurance, at 505-660-7108 or paige.duhamel@osi.nm.gov. ISSUED this 28th day of December, 2022. __________________________________ RUSSELL TOAL Superintendent of Insurance