Providers

Authorizations

 

​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

- OR -

Complete and submit Prior Authorization online

Pharmacy

Fax completed Prior Authorization forms to Presbyterian Pharmacy Services at (505) 923-5540 or at 1-800-724-6953.

- OR -

Complete and submit Prior Authorization online

Advanced Imaging Ordering Program

Presbyterian uses the Medical Specialty Solutions (MSS) program, managed by National Imaging Associates, Inc. (NIA), 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 MSS program. If you have any questions or concerns about the program, please contact your Provider Network Management relationship executive.

Submit a prior authorization to the MSS program

Behavioral Health

Need Assistance?

For assistance with Prior Authorization or Utilization Management issues please call 505-923-5757 or 1-888-923-5757. We may be reached using this number both during and after normal business hours.



Is Prior Authorization Required?

You can check to see if medical prior authorization is required.
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