N.M. Admin. Code § 13.10.17.26 - SUPERINTENDENT'S DECISION ON EXTERNAL REVIEW OF ADVERSE DETERMINATION
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.
Notes
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