Text Size

State of New Mexico - Human Services Department

Provider Resources

March 19, 2020: COVID-19 and Business Continuity

During the current COVID-19 emergency, Comagine Health is fully staffed and business operations are not interrupted.

For utilization review, case management and related activities, we are continuing to process requests and answer calls via our toll-free numbers during standard business hours. 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.

Provider Checklists


Admission Criteria

Uniform Prior Authorization Form

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

Fax Numbers for Requests for Authorization

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


  • 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

Provider Notices

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.



Adobe Acrobat® PDF files can be opened using Adobe Acrobat Reader. If you do not have Reader, you can get it free from the Adobe website.