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Level of Care Determination Scoring Instructions
Uniform Prior Authorization Form

Replaces MAD forms 301, 303 and 616 as of Jan. 1, 2020.

New Mexico Uniform Prior Authorization Form

Fax Numbers
  • Applied Behavior Analysis: 888-515-2067
  • MCO client information update requests: 888-562-2755
  • Mi Via participants: 800-251-9993
  • Urgent fee-for-service prior authorizations: 888-562-2755
Comagine Health Provider Portal

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

Go to the Comagine Health Provider Portal

For help or password resets, please call Comagine Health at 866-962-2180.

To get started with the Comagine Health Provider Portal, please complete the registration packet and email it to After we receive your registration packet we will send you an email with your login credentials.

Comagine Health Provider Portal Registration Packet

Administrator Guide

Administrator Guide (June 5, 2023)

User Guide

User Guide (June 5, 2023)

Quick Start Guides


Comagine Health Provider Portal Upgrade (May 2023)

Compliments and Complaints Letter