Provider Resources

December 18, 2020: COVID-19 and Business Operations Update
During the current COVID-19 Public Health Emergency, Comagine Health remains fully staffed and major business operations are not experiencing any interruptions. We continue to process requests and answer calls via our toll-free number during standard business hours. Our New Mexico toll-free number is 1-866-962-2180. We have business continuity plans in place to serve our clients, health care providers, patients and communities while also protecting our staff and minimizing the spread of the illness.

All staff in the New Mexico office are working remotely in order to adhere to the Public Health Emergency Order. Comagine Health will follow the reopening gating criteria for Bernalillo County.

Due to staff working remotely, mailed letters to New Mexico Medicaid members and waiver recipients/participants will be suspended until staff are able to safely return to the office. 

Comagine Health will send Request for Information (RFI), Approval and Denial Letters to recipients/participants if a valid email address is on file. The case managers, consultants, community support coordinators and providers are encouraged to provide the recipient’s/participant’s email address in the Comagine Health Provider Portal Note section.

As always, the case managers, consultants, community support coordinators and providers may view and print the letter correspondence directly from the Comagine Health Provider Portal. 

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
• Program of All-Inclusive Care for the Elderly (PACE) Level of Care
• Supports Waiver – Agency Based Budget Model
• Supports Waiver Level of Care – Agency Based & Participant Directed
• Supports Waiver – Participant Directed

Coversheet

• Developmental Disabilities Waiver Third Party Assessor Coversheet

Admission Criteria

• ICF/IID Admission Criteria

Uniform Prior Authorization Form

This form replaces MAD forms – 301, 303 and 616 as of January 1, 2020.

• Uniform Prior Authorization Form

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

Comagine Health Provider Portal

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

Go to the Comagine Health Provider Portal

Getting Started: Register

Get started by registering to use the Comagine 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 Comagine Health Provider Portal registration packet

Comagine 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 Support Waiver Agency Based & Participant Directed Budgets
  • Submitting Support Waiver Agency Based & Participant Directed Level of Care
  • 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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