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Provider Forms

 

You'll find all forms we currently use in the following list. Check back frequently to get the most current and up-to-date forms.

Note – Indian Health Services (IHS), Tribal 638 facilities, Skilled Nursing Facilities (SNF) and Home and Community Based Service (HCBS) providers are not required to use the reconsideration form.  These facilities should continue working with their designated points of contact within UnitedHealthcare Community Plan of New Mexico.

 

BH Level of Care Guidelines (PDF 173.88 KB)

BH ABA Stage 3: Initial & Concurrent Prior Authorization Form (PDF 81.62 KB)

BH ABA SpecCare Providor Prior Authorization Form (PDF 92.34 KB)

Centennial Care Prior Authorization Form (PDF 106.44 KB)

NM 2015 State of NM Joint MCO Centennial Medicaid Disclosure Form