Comagine Health provides third-party assessor and utilization review services to the New Mexico Human Services Department/Medical Assistance Division (HSD/MAD). We strive to improve and advance the efficiency, effectiveness and quality of health care services provided to New Mexico Medicaid recipients. Our staff includes New Mexico residents, and our regional office is located in Albuquerque.
New Mexico Medicaid Services
We conduct level of care (LOC) reviews for:
- Developmentally Disabled Waiver
- Intermediate care facilities (ICF/IID)
- Medically Fragile Waiver
- Mi Via Waiver
- Nursing facilities (NF)
- Program of All-Inclusive Care for the Elderly (PACE)
- Supports Waiver
We conduct budget reviews for:
- Developmentally Disabled Waiver
- Medically Fragile Waiver
- Mi Via Waiver
- Supports Waiver
We conduct fee-for-service (FFS) utilization management reviews for:
- Behavioral health requests
- Emergency Medical Services for Non-Citizens (EMSNC)
- Prior authorizations
Learn More About New Mexico Medicaid
For more information about New Mexico Medicaid, please visit the New Mexico Human Services Department website at http://www.hsd.state.nm.us.
Access supplements to the MAD New Mexico Administrative Code program rules at https://www.hsd.state.nm.us/providers/Registers_and_Supplements.
Announcements
We have updated the Quick Start Guide for submitting UNM C.O.R.E. budget requests. You also can find a link to the guide on the Providers page in the Comagine Health Provider Portal section.
Comagine Health has completed our New Mexico Medicaid website migration.
Effective July 1, 2021, the New Mexico Medicaid webpages on qualishealth.org will move to the new website.
The new web address is https://comagine.org/program/new-mexico-medicaid.
New Mexico Medicaid webpages on the Qualis Health website will be automatically redirected to the new Comagine Health website for the first year. After July 2022, automatic redirections will not occur; please save the new website for future reference.
We are still doing level of care (LOC) in-home assessments (IHAs) using the computer or cell phone during the pandemic. IHAs are done using Zoom. Zoom is an online audio and web conferencing service that people use for video conference meetings. Many Mi Via participants have successfully completed their virtual IHAs using Zoom.
We understand that some families may not be familiar navigating Zoom. Goodwill has compiled several easy to follow guides to assist families with Zoom. Please encourage your participants to visit https://www.nmhealth.org/about/ddsd/pgsv/sdw/publications for more information.
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.
The new 1915(c) Supports Waiver began on July 1, 2020. For training documents and information on how to submit Supports Waiver requests to Comagine Health, please refer to the Quick Start Guides and Checklists on the Providers page.
The New Mexico Medicaid Out-of-State Service Request Checklist has been revised as of April 2020.
Due to COVID-19, the 1915(c) Waiver Level of Care (LOC) Reminder Letters will not be sent out. Instead, a reminder call will be placed to the waiver participants. The necessary forms (MAD 378 and History and Physical forms) to submit an LOC request can be downloaded for their convenience.
The Uniform Prior Authorization Form replaces MAD forms 301, 303 and 616 as of Jan. 1, 2020.
Effective Dec. 1, 2018, Comagine Health will be completing prior authorization requests for Applied Behavior Analysis (ABA) Stage 3 services for the fee-for-service (FFS) population. This does not apply to clients who are enrolled with a managed care organization (MCO).
Please fax FFS ABA prior authorization requests to Comagine Health at 1-888-515-2067.