Provider Resources

Provider Checklists

• Acute Rehabilitation Hospital
• Alternative Benefit Plan (ABP) Exemption
• Applied Behavior Analysis (ABA)
• Dental
• Developmental Disabilities Traditional Waiver Budget
• Developmental Disabilities Traditional Waiver Level of Care
• EMSA
• Fee for Service
• ICF/IID Initial Level of Care
• Mi Via Developmental Disabilities Level of Care
• Mi Via Medically Fragile Level of Care
• Mi Via Service and Support Plan (SSP)/Budget
• Non-DRG LTAC Hospital
• Out-of-State Service
• Physical Therapy/Occupational Therapy
• Program of All-Inclusive Care for the Elderly (PACE) Level of Care

Coversheet

• Developmental Disabilities Waiver Third Party Assessor Coversheet

Admission Criteria

• ICF/IID Admission Criteria

Fax Numbers for Requests for Authorization

Applied Behavior Analysis: (888) 515-2067 toll-free

Waivers:

• Jackson Class Urgent: (877) 850-7269 toll-free
• MCO Client Information Update Requests: (888) 562-2755 toll-free
• Mi Via Participants: (800) 251-9993 toll-free

Urgent Fee for Service Prior Authorizations:
(out-of-state providers & infrequent users—submit less than 12 requests per year)
(888) 562-2755 toll-free

Qualis Health Provider Portal

The Qualis Health Provider Portal is a web-based application for submitting authorization requests.

Go to the Qualis Health Provider Portal

Getting Started: Register

Get started by registering to use the Qualis Health Provider Portal. Complete the appropriate forms in the registration packet and email them to Qualis Health. We will contact you once we receive your registration packet.

Download the Qualis Health Provider Portal registration packet

Qualis Health Provider Portal Resources

• Quick Start Guides
  • Submitting Completed IHAs and Notes
  • Submitting Dental Authorization Requests
  • Submitting Home & Community Based Waiver LOC Documents
  • Submitting ICF/IID Requests
  • Submitting Medical Outpatient Authorization Requests
  • Submitting Mi Via Budget Requests
  • Submitting Mi Via LOC Requests
  • Submitting PACE Requests
  • Submitting Traditional Annual LOC Requests
  • Submitting Traditional Budget Requests
  • Submitting UM Authorization Requests
  • Submitting UNM C.O.R.E. Budget Requests
     
• System Updates
  • March 28, 2017
     
• User Guide (August 25, 2016)
   
• Administrator Guide (August 15, 2017)
   
• Frequently Asked Questions
  • All Users
  • Waiver Users
     
• Training Videos - General Information
  • Registering
  • Logging In and Getting Started
  • Searching for Requests
  • Responding to Requests for Information
  • Administrator Tasks
     
• Training Videos - Submitting Requests
  • Submitting Dental Authorization Requests
  • Submitting Medical Outpatient Authorization Requests
  • Submitting Mi Via Budget Requests
  • Submitting Mi Via LOC Requests
  • Submitting Traditional Annual LOC Requests
  • Submitting Traditional Budget Requests
  • Submitting UNM C.O.R.E. Budget Requests
     
• On-demand Training
  
  Learn how to use the Qualis Health Provider Portal in just one 30–60 minute training session. The session is only for your site or team, so you get only the information that's important to you.
  
  Email Qualis Health at nmtraining@qualishealth.org to schedule your training.

Provider Notices

• Compliments & Complaints Letter (October 28, 2016)

Introduction to Qualis Health's Services

• 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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