New Mexico Administrative Code
Title 13 - INSURANCE
Chapter 10 - HEALTH INSURANCE
Part 17 - GRIEVANCE PROCEDURES
Section 13.10.17.26 - SUPERINTENDENT'S DECISION ON EXTERNAL REVIEW OF ADVERSE DETERMINATION
Universal Citation: 13 NM Admin Code 13.10.17.26
Current through Register Vol. 35, No. 18, September 24, 2024
A. Deliberation. At the close of the hearing, the hearing officers shall review and consider the entire record and prepare findings of fact, conclusions of law and a recommended decision within 30 days for a standard review. Any hearing officers may submit a supplementary or dissenting opinion to the recommended decision.
B. Order. Within 10 days after receiving the recommendation of the ICOs, the superintendent will issue an appropriate order. If the order requires action on the part of the health care insurer, the order shall specify the timeframe for compliance:
(1) The order shall
be binding on the grievant and health care insurer and shall state that the
grievant and the health care insurer have the right to judicial review pursuant
to Section
59A-4-20 NMSA
1978 and that state and federal law may provide other remedies.
(2) Neither the grievant nor the health care
insurer may file a subsequent request for external review of the same adverse
determination that was the subject of the superintendent's order.
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