New Mexico Administrative Code
Title 13 - INSURANCE
Chapter 10 - HEALTH INSURANCE
Part 31 - PRIOR AUTHORIZATION
Section 13.10.31.7 - DEFINITIONS
Universal Citation: 13 NM Admin Code 13.10.31.7
Current through Register Vol. 35, No. 18, September 24, 2024
Terms used in these rules are as defined in Section 59A-22B-2 NMSA 1978, and in 13.10.29 NMAC, except as supplemented and superseded below.
A. "Benefit" means any medical service, medical service location, medical provider selection, pharmaceutical, or medical supply that is the subject of a prior authorization request.
B. "Utilization review organization" or "URO" means an entity engaged by a carrier to determine medical necessity for covered services. A URO includes a pharmacy benefits manager ("PBM") who determines medical necessity for a carrier's prescription drug coverage.
Disclaimer: These regulations may not be the most recent version. New Mexico may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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