Provider Directories

STATE OF NEW MEXICO OFFICE OF SUPERINTENDENT OF INSURANCE P.O. Box 1689, Santa Fe, NM 87504-1689 1120 Paseo de Peralta, Room 428, Santa Fe, NM 87501 Phone: (505) 827-4601; Fax (505) 827-4734 SUPERINTENDENT OF INSURANCE John G. Franchini (505) 827-4299  DEPUTY SUPERINTENDENT Robert Doucette (505) 827-5832 # BULLETIN NO. 2016-014 TO: NONPROFIT HEALTH CARE PLANS, HEALTH MAINTENANCE ORGANIZATIONS, AND PREFERRED PROVIDER ORGANIZATIONS OFFERING QUALIFIED HEALTH PLANS IN THE HEALTH INSURANCE MARKETPLACE FROM: JOHN G. FRANCHINI, SUPERINTENDENT OF INSURANCE DATE: MAY 26, 2016 RE: PROVIDER DIRECTORIES # I. BACKGROUND AND PURPOSE The State of New Mexico Office of the Superintendent of Insurance is legally required to regulate health insurance coverage for the state of New Mexico as well as conduct marketplace plan management required for insurers' participation in the federally-supported, state-based marketplace (SSBM). Included and in conjunction with these duties, the Office of the Superintendent of insurance (OSI) must perform regular functions to approve forms, templates, network adequacy, and review rates for all health plans sold in New Mexico. The Office of the Superintendent of Insurance's goal is to make health plan regulation as efficient and streamlined as possible for health insurers, thereby reducing costs and creating a level playing field. Bulletins are OSI's interpretations of existing insurance law or general statements of OSI policy. Bulletins themselves establish neither binding norms not a final determination of rights.  ## II. APPLICABILITY AND SCOPE This notice is issued to all entities (insurers) issuing health insurance policies on the health insurance marketplace subject to the jurisdiction of the Office of the Superintendent (OSI). ### III. PROVIDER DIRECTORIES Beginning July 1, 2016, and on the 15th of each month moving forward, all insurance carriers offering qualified health plans through New Mexico's Health Insurance Marketplace (BeWellNM) are required to submit their health plan provider contracted network lists in a standardized format. Qualified health plan carriers must submit their contracted healthcare provider lists using the OSI Provider List Template format in an Excel workbook with an .xls or.xlsx file extension. The OSI Provider List Template can be found via the New Mexico Office of the Superintendent of Insurance, Life and Health Rate and Form Filing Website - http://www.osi.state.nm.us/LifeHealthFiling/index.aspx. Carriers must submit the Provider List Template with a file name using the carrier name, plan name, metal level or tier, if applicable, and date the last date by which that data was updated. The Provider List Template includes a required field for each provider's National Provider Identifier Number. If you do not know the NPI for your provider, please contact the provider to acquire it. If a provider does not have an NPI, enter 0000000000 (10 digits) in the NPI field. If a healthcare provider has more than one location, that healthcare provider should be listed for each location in separate rows in the Excel worksheet. Please use the Glossary of Terms on the second tab of the file for an explanation of the template's information fields.