GOLD CARDING REPORTING PURSUANT TO 13.10.31.12

STATE OF NEW MEXICO OFFICE OF SUPERINTENDENT OF INSURANCE SUPERINTENDENT OF INSURANCE Alice T. Kane Main Office: 1120 Paseo de Peralta, Fourth Floor, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 400, Albuquerque, NM 87110 Main Phone: (505) 827-4601 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us BULLETIN 2023-020 July 17, 2023 TO: ALL MAJOR MEDICAL HEALTH INSURANCE CARRIERS PROVIDING MEDICAL SERVICES RE: GOLD CARDING REPORTING PURSUANT TO 13.10.31.12 Section 13.10.31.12 NMAC of the Prior Authorization Rule requires major medical insurers to report on efforts to evaluate prior authorization policy and provider performance. This regulation requires annual reporting by insurers by September 30th of each year. Accordingly, all entities subject to the rule shall complete and submit to OSI the data reporting form available for download on OSI’s website at https://www.osi.state.nm.us/pages/bureaus/mcb/resources/utilization-management. Additionally, entities subject to the rule shall provide a narrative describing its evaluation of its prior authorization processes this past year and any additional reporting requirements pursuant to 13.10.31.12(B) and (D). Reporting shall be done by close of business September 30th or the first business day thereafter. Failure to timely submit a completed report is subject to the administrative penalties outlined in Section 59A-22B-4 NMSA 1978 of the Act. Any questions should be directed to Paige Duhamel at her email address (paige.duhamel@osi.nm.gov) or via telephone at (505) 660-7108. Every subject entity shall report data for fully-insured lines of major medical business; null reporting is not required. Data shall be reported via SERFF as an information filing under the Network Adequacy TOI. B U L L E T I N 2 0 2 3 - 0 2 0 P a g e | 2 Main Office: 1120 Paseo de Peralta, Fourth Floor, Santa Fe, NM 87501 Satellite Office: 6200 Uptown Blvd NE, Suite 400, Albuquerque, NM 87110 Main Phone: (505) 827-4601 | Toll Free: (855) 4 - ASK - OSI www.osi.state.nm.us ISSUED this 17th day of July 2023. __________________________________ ALICE T. KANE Superintendent of Insurance