New Mexico: Start Here
Beginner guide for New Mexico—beWellnm, OSI/IRO external review, 59A-22B PA & grievance deadlines.
Read guideState playbook
New Mexico
State insurers, legislation, and appeal resources for patients and advocates in New Mexico.
4 guides
New Mexico Prior Authorization Law
NMSA 59A-22B—7-day/24-hour PA, deemed granted, protected drug classes, 13.10.31 NMAC carrier rules.
Read guideNew Mexico Health Insurance Appeals and Grievances
Appeal within 180 days—30/60-day decision, 72-hour expedited, deemed approved, path to OSI IRO review.
Read guideNew Mexico External Review (OSI / IRO)
Binding on carrier—four-month filing with OSI MHCB, 45-day IRO decision, 72-hour expedited.
Read guidePrior auth & internal appeals
Match the plan on the member ID card. Use the denial letter for where to file appeals.
- Blue Cross Blue Shield of New Mexico
- Molina Healthcare of New Mexico
- Presbyterian Health Plan
- UnitedHealthcare of New Mexico
- beWellnm (Marketplace)
- Centennial Care (Medicaid)
External appeals
After internal appeal, for eligible New Mexico fully insured plans only.