TIMELINESS AND COMPLETENESS OF CORRESPONDENCE RELATED TO MEMBER GRIEVANCES

STATE OF NEW MEXICO OFFICE OF SUPERINTENDENT OF INSURANCE INTERIM SUPERINTENDENT OF INSURANCE 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 2023-002 FEBRUARY 3, 2023 TO: ALL MAJOR MEDICAL HEALTH INSURERS SUBJECT TO THE JURISDICTION OF THE OFFICE OF SUPERINTENDENT OF INSURANCE RE: TIMELINESS AND COMPLETENESS OF CORRESPONDENCE RELATED TO MEMBER GRIEVANCES This Bulletin is issued to improve the processes required by the Member Grievance Rule, 13.10.17 NMAC, and to remind insurers of their obligations under that Rule. Specifically, that insurers must timely provide complete documents and responses to the OSI Managed Health Care Bureau (MHCB), including under the following circumstances: a) Insurers shall promptly and completely furnish any documents requested by the MHCB in relation to a grievance. NMSA 1978, Section 59A-4-3 (1984). b) Insurers must comply with all deadlines set by the MHCB. c) Insurers must provide complete information to status requests sent by MHCB. Such information shall include the dollar amount associated with a grievance and the billing history from the insurer and the provider(s). When requested by the MHCB, the full medical record shall be provided promptly to OSI. Failure to comply with this Bulletin may lead to the imposition of fines and penalties pursuant to NMSA 1978, § 59A-1-18. OSI warns that these fines and penalties may include an issuance of a daily fine for any incomplete or late filed response to an MHCB request in relation to a member grievance. However, as always, OSI thanks insurers for their partnership and cooperation. B U L L E T I N 2 0 2 3 - 0 0 2 P a g e | 2 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 | Satellite Phone: (505) 322-2186 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us Any Questions can be directed to the Staff Manager for Managed Health Care Bureau at Gurrattanpal.Singh@osi.nm.gov or 505-231-9013 ISSUED this 3nd day of February 2023. __________________________________ JENNIFER A. CATECHIS Interim Superintendent of Insurance