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Private Insurance Data Requirements in New Mexico

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        All insurers are required to maintain separate records for all data required by the Superintendent of Insurance as well as file an annual report with the Superintendent.1  Insurance companies must provide all beneficiaries with a written disclosure statement that explains the primary features of the plan and lays out what the plan does not cover.2

        Health care providers and facilities cannot disclose STD test results or the identity of the tested individual except in limited circumstances, including for insurance purposes.3

        The Patient Protection Act requires all managed care plans in New Mexico to have an office that responds to consumer’s questions and problems.4  All health maintenance organizations (HMO) must have grievance procedures in place and must maintain records of all grievances that are filed.5

 

Footnotes

  • 1. N.M.S.A. §59A-23B-7
  • 2. N.M.S.A. §59A-23B-5
  • 3. N.M.S.A. §24-2B-6
  • 4. N.M.S.A. §59A-57-4
  • 5. N.M.S.A. §59A-46-11

 

Private Insurance Data Requirements in New Mexico

Subtopic Statute/Regulation Description
Access to individual’s own records (Cross reference Medical Records Collection) Access to medical records by applicants for disability benefits; violations – N.M. Stat. Ann. § 14-6-3 These requirements apply to any person who is licensed, certified or otherwise authorized by law to provide or render health care, as well as to any...
Production of Records – N.M. Code R. § 7.1.10.9 Production of records   Any medical records requested by an individual must be produced within 30 days of the written request, regardless...
Requirement of Written Request – N.M. Code R. § 7.1.10.8 Requirement of written request   An individual that is applying for or appealing a denial of social security benefits has the right to receive...
Disclosure of information held by health plan, including notice requirements Confidentiality of medical information and limitation of liability-N.M. Stat. Ann. §59A-46-27 A health maintenance organization (HMO) must maintain the confidentiality of any information of an enrollee dealing with his/her diagnosis, treatment...
Policy or plan disclosure requirements – N.M. Stat. Ann. §59A-23B-5 Once insurance coverage is offered, an insurer must provide a written disclosure statement to the beneficiary of a plan under the Minimum Healthcare...
Grievance procedures Consumer assistance; consumer advisory boards; ombudsman office; reports to consumers; superintendent's orders to protect consumers – N.M. Stat. Ann. §59A-57-5 New Mexico has adopted a Patient Protection Act.  The Act provides that all individuals enrolled in a managed care plan have the right to be...
HMO Grievance Procedures – N.M. Stat. Ann. §59A-46-11 A health maintenance organization (HMO) must have grievance procedures in place, and must maintain records of any grievances filed by enrollees.
Health plan required reporting Data Reporting Requirements for Health Plans – N.M. Code R. §7.1.21 A health plan must report to the New Mexico Health Policy Commission the Health Plan Employer Data and Information set (published by the National...
Recordkeeping and reporting requirements – N.M. Stat. Ann. §59A-23B-7 All insurers providing insurance pursuant to the Minimum Healthcare Protection Act must maintain separate records for enrollment, claim costs,...
Private Insurance Data Requirements Disclosure of information by health insurance issuers; offering health insurance coverage to small employers-N.M. Stat. Ann. § 59A-23E-15 Health insurance plans offering health coverage to small employers must make reasonable disclosures regarding the plan’s ability to change...
HMO Quality Assurance – N.M. Stat. Ann. §59A-46-7 A health maintenance organization (HMO) must have procedures in place the ensure that enrollees receive quality care, including availability,...
Information to enrollees or subscribers-N.M. Stat. Ann. § 59A-46-10 All health maintenance organizations must provide subscribers and enrollees with a list of providers at the start of enrollment. If a health...
Notice of claim-N.M. Stat. Ann. § 59A-22-8 All health insurance contracts must state that the covered individual must notify the insurance company within 20 days about any loss covered by the...
Patient rights; disclosures; rights to basic and comprehensive health care services; grievance procedure; utilization review program; continuous quality program – N.M. Stat. Ann. §59A-57-4 New Mexico’s Patient Protection Act requires all managed care plans to have an adequately staffed consumer assistance office to respond to...
Preexisting condition; definition; coverage-N.M. Stat. Ann. § 59A-23A-7 All long-term care insurance policies defining “preexisting condition” must not use a definition more restrictive than “a condition...
Prescription drugs; prohibited formulary changes; notice requirements-N.M. Stat. Ann. § 59A-22-49.4 Beginning on January 1, 2014, health insurance plans that cover prescription drugs under a cost-sharing method cannot change their coverage of...
Prescription drugs; prohibited formulary changes; notice requirements-N.M. Stat. Ann. § 59A-46-50.4 Beginning on January 1, 2014, health insurance plans that cover prescription drugs under a cost-sharing method cannot change their coverage of...
Sexually transmitted diseases; confidentiality – N.M. Stat. Ann. §24-1-9.4 Any person who administers a test for a sexually transmitted disease, or his or her agents, may not disclose the identity of the person being tested...
Cost reporting by insurance companies (Cross reference Provider Resource Use) Recordkeeping and reporting requirements – N.M. Stat. Ann. §59A-23B-7 All insurers providing insurance pursuant to the Minimum Healthcare Protection Act must maintain separate records for enrollment, claim costs,...
Click on the individual state law in the table above to see our summary of the individual law.


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