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State of New Mexico - Human Services Department


Qualis Health provides third party assessor and utilization review services to the State of New Mexico Human Services Department Medical Assistance Division (HSD/MAD). Our regional office is located in Albuquerque, NM. Qualis Health strives to improve and advance the efficiency, economy, effectiveness and quality of healthcare services provided to enrolled New Mexico Medicaid recipients.


Services We Provide to New Mexico Medicaid

  • Level of Care (LOC) Review
    • Mi Via Waiver
    • Medically Fragile Waiver
    • Developmentally Disabled Waiver
    • Program of All Inclusive Care for the Elderly (PACE)
    • Intermediate Care Facilities (ICF/IID)
  • Utilization Management Review for Fee-for-Service (FFS)
    • Prior Authorization
    • Behavioral Health
    • EMSA


Announcements

Please check this page frequently for updates about provider training and resources.

August 4, 2017: Coming Soon—QHPP Required for Developmental Disabilities and Medically Fragile Waiver Requests
Effective August 14, 2017, developmental disabilities and medically fragile waiver requests must be submitted through the Qualis Health Provider Portal.

Advance registration is required to use the Qualis Health Provider Portal. If you haven’t already registered, please submit a QHPP registration packet. You can also find a link to the packet on the Provider Resources page.

If you have questions, please call Qualis Health at (866) 962-2180, Monday–Friday, 8:00 am–5:00 pm Mountain Time.

August 1, 2017: QHPP Required for Behavioral Health and Dental Prior Authorization Requests
Effective August 1, 2017, behavioral health and dental prior authorization requests must be submitted through the Qualis Health Provider Portal.

Advance registration is required to use the Qualis Health Provider Portal. If you haven’t already registered, please submit a QHPP registration packet. You can also find a link to the packet on the Provider Resources page.

If you have questions, please call Qualis Health at (866) 962-2180, Monday–Friday, 8:00 am–5:00 pm Mountain Time.

July 7, 2017: Updates to June 2 Announcement
The Qualis Health Provider Portal registration deadline has been extended to July 15, 2017. We have also added more sessions to the Qualis Health Provider Portal training schedule.

Please see the announcement below dated June 2, 2017, for details.

June 15, 2017: Two New Qualis Health Provider Portal Quick Start Guides Added
There are two new Qualis Health Provider Portal Quick Start Guides available: Submitting PACE Requests and Submitting UM Authorization Requests. Links to these documents are also on the Provider Resources page under the heading “Qualis Health Provider Portal.”

June 5, 2017: All Quick Start Guides Updated
We have updated all of the Qualis Health Provider Portal Quick Start Guides. Links to the Quick Start Guides are on the Provider Resources page under the heading “Qualis Health Provider Portal Resources.”

June 2, 2017: Transition to Online Review Requests Coming Soon
The Human Services Department/Medical Assistance Division (MAD) is implementing the Qualis Health Provider Portal (QHPP) effective September 5, 2017. The QHPP in the Jiva web-based care management system gives healthcare providers a two-way link using the Internet to securely exchange care management information.

All Fee-for-Service providers rendering services that require a prior authorization or level of care, as well as Home- and Community-Based Waiver case managers and consultants, are required to obtain access to the QHPP to submit prior authorization and level of care requests. Providers will also retrieve prior authorization and level of care correspondence documents through the QHPP.

In order to submit requests via the Qualis Health Provider Portal, your organization must be registered no later than July 1, 2017.


June 1, 2017: Out-of-State Service Request Checklist Updated
We have updated the Out-of-State Service Request provider checklist. You can find it on the Provider Resources page under the heading “Provider Checklists.”

March 31, 2017: Updates to Qualis Health Provider Portal Effective April 1
We have made several improvements to the Qualis Health Provider Portal that take effect on April 1, 2017. Please read the System Updates for a summary of these changes. You can also find the System Updates document on the Provider Resources page in the “Qualis Health Provider Portal Resources” section.

February 27, 2017: Developmental Disabilities Waiver Coversheet Now Online
We have posted the Developmental Disabilities Waiver Third Party Assessor Coversheet on the Qualis Health website. Find it on the Provider Resources page in the “Coversheet” section.

January 27, 2017: New Mi Via Provider Checklists Published
Two new provider checklists are now online: Mi Via Developmental Disabilities Level of Care Review and Mi Via Medically Fragile Level of Care Review. These replace the Mi Via Level of Care Review checklist. The Provider Resources page also contains links to these checklists.

November 4, 2016: New Provider Notice Describes Feedback Process
In the new Compliments & Complaints Letter, we describe our system for handling feedback from a variety of sources, including clients, providers and patients. This letter is located on the Provider Resources page under the heading “Provider Notices.” We welcome your input!

October 18, 2016: Physical Therapy Review Provider Checklist Added
We have created a provider checklist for physical therapy therapy review submission. You can also find it on the Provider Resources page under the "Provider Checklists" heading.

September 15, 2016: New and Updated Qualis Health Provider Portal Guides Available
We have made some changes to the Qualis Health Provider Portal User Guide, as well as added an Administrator Guide. You can find links to these guides on the Provider Resources page.

Download Flyers to Learn More About the Services We Provide to New Mexico Medicaid

  • Download this flyer for more information about the Level of Care Review services we provide and how to access those services.
  • Download this flyer for more information about the Utilization Management Review for Fee for Service services we provide and how to access those services.

 

 

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