Certain specialized services and prescription drugs require a prior authorization or inpatient notification before being rendered to patients and members. Prior authorizations and inpatient notifications ensure that patients are receiving the right amount of medically necessary care in the right setting for the insurance plan for which they're enrolled.
Medical
Fax completed Prior Authorization form to Presbyterian at:
Prior Authorization (505) 843-3047
Inpatient Utilization Management (505) 843-3107
Home Health Care (505) 559-1150
UNM Prior Authorization (505) 843-3108
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Complete and submit Prior Authorization online
Pharmacy
For the most up-to-date formulary drug information access the Provider Formularies page. Formulary drug coverage status and additional restrictions are listed in the plan’s formulary (drug list).
Provider FormulariesPharmacy Authorizations
Submit an Electronic Prior Authorization, or ePA, request online or through your Electronic Health Record (EHR) System.
To submit an ePA online, visit www.covermymeds.com.
Many EHRs have ePA capabilities built into the workflow. For more information on if your EHR has ePA capabilities or how to use it, please contact your EHR help desk or administrator.
- OR -
Fax completed Prior Authorization forms to Presbyterian Pharmacy Services at (505) 923-5540 or at 1-800-724-6953.
Advanced Imaging Ordering Program
Presbyterian uses the Advanced Imaging Program, managed by Stanson Health, for prior authorizations of both non-emergent, advanced diagnostic imaging procedures and cardiac-related imaging procedures performed in an outpatient setting. The program is designed to streamline the authorization process, reduce healthcare costs, and improve patient outcomes. The documents below provide additional information about the advanced imaging program. If you have any questions or concerns about the program, please contact your Provider Network management relationship executive.
Stanson Health Care Portal Stanson Health Resources and Criteria
Musculoskeletal Surgery (Spine) Ordering Program
Presbyterian uses the Medical Specialty Solutions (MSS) program, managed by Evolent Specialty Services, for prior authorizations. The program is designed to streamline the authorization process, reduce healthcare costs and improve patient outcomes. The documents below provide additional information about the MSS program. If you have any questions or concerns about the program, please contact your Provider Network Management relationship executive.
Behavioral Health
Behavioral Health Medical Necessity Criteria (Medicare/Commercial)
Fax completed Prior Authorization form to Presbyterian at:
Turquoise Care BH: (505) 843-3019
Medicare/Commercial BH: 1-888-656-4967
- OR -
Complete and submit Prior Authorization online (Medicare/Commercial) Complete and submit Prior Authorization online (Turquoise Care only)
