When medical care on a New Mexico workers' compensation claim is disputed, a party can ask the Workers' Compensation Administration's Medical Cost Containment Bureau to conduct utilization review. The one-page request identifies the requestor, payor, attorneys, employer and worker, and describes the reason for review. Since July 1, 2026, utilization review has its own form, separate from billing disputes and case management requests.
The requesting party completes and signs the whole form; this is commonly the health care provider or its office, though an insurer or worker may also file. It covers the requestor, the payor and its attorney, the worker and the worker's attorney, and the reason for the request.
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Utilization Review Request
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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Only the medical reasonableness, clinical necessity, efficiency and quality of the treatment under review. The form states that utilization review does not decide compensability issues, including the causal link between the treatment and the work injury, whether the worker is disabled, or whether the worker has reached maximum medical improvement.
Effective July 1, 2026, the Medical Cost Containment Bureau stopped using one combined form. Billing disputes, case management requests and utilization reviews each now have a separate form, so a provider requesting utilization review should use this Utilization Review Request rather than the older combined form.
The form asks the requester to confirm the request meets the eligibility criteria cited on the form under 11.4.7.12 NMAC, that all relevant medical records are attached, and that attorneys on both sides were alerted before the request was made, then to sign and date the attestation.