Verified October 10, 2026 against the statutes, regulations and sources cited below. General information, not legal advice. All states
What providers miss in New Mexico
- The superintendent's provider complaint form lists network adequacy and participation decisions based on network composition as complaint types, which is unusual among insurance regulators.
- Carriers may lawfully deny an application because the network is already adequate, so a complaint works best on missed deadlines or a documented access gap.
Does New Mexico have an any willing provider law?
No any willing provider law was confirmed. The credentialing rule says a carrier is not obligated to approve every application and may deny one based on existing network adequacy.
Citation: 13.10.28.10 NMAC
How long can a plan take to credential a provider in New Mexico?
Carriers must approve or deny within 30 days of a completed application, extendable by 15 days for sanctions, investigations or similar issues. If no decision comes within 45 days, the provider may request review under the carrier's internal dispute process.
- Deadline: 30 days
- Applies to: HMOs, health insurers and nonprofit health care plans; physicians and other practitioners
Citation: NMSA 59A-22-54, 59A-46-54, 59A-47-49; 13.10.28.11 NMAC
Can a provider practice in network while New Mexico plans credential them?
A carrier must pay clean claims for services more than 30 days after a complete application if it has not decided in time, when the provider has no license sanctions and carries malpractice coverage. Group members are paid at the group's contract rate, others at the carrier's standard rate.
- Provisional or interim credentialing
Citation: 13.10.28.12 NMAC
What network adequacy rules apply in New Mexico?
Each managed health care plan must keep an adequate network and file an access plan the superintendent approves or rejects.
Citation: 13.10.22.8 NMAC
Superintendent review of credentialing payment disputes
If a dispute over claims during a delayed credentialing decision is not resolved inside the carrier within 45 days, the provider may complain to the superintendent, who may order payment at the standard rate and decides within 30 days.
Citation: 13.10.28.13 NMAC
Will the New Mexico insurance department take a provider complaint?
- New Mexico Office of Superintendent of Insurance
- Takes provider complaints
Who oversees Medicaid managed care plans in New Mexico?
- New Mexico Health Care Authority (Turquoise Care)
Turned down by a plan in New Mexico?
We read the denial, check which of these rules reach that plan, and prepare the reconsideration request, the access-gap evidence and any regulator complaint the law supports; you sign and send them, and we track every deadline. Self-funded employer plans follow federal law, not New Mexico's. A rejection review is $249, credited toward a dispute.
Sources
- insuranceDept (credentialing deadlines, network adequacy and contract compliance complaint types), notes
- anyWillingProvider.summary, provisionalCredentialing, extras (2017 rule text, which used a 45-day clock)
- networkAdequacy
- credentialingDeadline (30 days plus 15, review at 45 days), provisionalCredentialing (payment after 30 days)