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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.

July 27, 2018: New Quick Start Guide for Submitting Home and Community-Based Waiver LOC Documents
The newest quick start guide provides instructions for adding Home and Community-Based waiver level of care documents in the Qualis Health Provider Portal. You can find a link to it on the Provider Resources page under “Qualis Health Provider Portal Resources.”

As of July 1, 2018, Qualis Health staff is building all Home and Community-Based waiver LOC annual reviews in the Qualis Health Provider Portal. Reminder notices will be sent to waiver clients 90 and 45 days prior to their LOC expiration date. Case managers will receive alerts in the Qualis Health Provider Portal.

February 26, 2018: New Provider Checklist for Alternative Benefit Plan Exemption Requests
This new checklist provides guidance on how to request an Alternative Benefit Plan (ABP) exemption. You can also find a link to it on the Provider Resources page under “Provider Checklists.”

January 17, 2018: DD Waiver TPA Coversheet Updated
The Developmental Disabilities Waiver Third Party Assessor Coversheet has been updated. You can find it 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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