Manuals, Forms and Resources
Manuals
Forms
Western Sky Community Care Forms
- PCP Change Form
- Notification of Pregnancy (NOP) Letter and Form (PDF)
- Outpatient Medicaid Prior Authorization Form (PDF)
- Inpatient Medicaid Prior Authorization Form (PDF)
- Provider Appeal Form (PDF)
- Pharmacy Retail Prior Authorization Form (PDF)
- Telemedicine Guide (PDF)
Behavioral Health
- Behavioral Health Level of Care Guidelines (PDF)
- Behavioral Health Clinical Notification Form (PDF)
- Initial Clinical Review Form (PDF)
- Concurrent Clinical Review Form (PDF)
- Retrospective Clinical Review Form (PDF)
- Discharge Clinical Review Form (PDF)
- ABA Initial-Concurrent Clinical Review Form (PDF)
- ABA Specialty Care Providers PA Form (PDF)
Questions related to Behavioral Health Codes requiring a Prior Authorization should be directed to Behavioral Health Department at (505) 886-6351.
New Mexico State Forms
- MAD 378 - Long Term Care Medical Assessment Abstract Form (PDF)
The Long Term Care Medical Assessment form (MAD 378 or “Abstract”) is used in the Medicaid program to assess and issue prior authorizations for Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) Level of Care (LOC). Medical providers (physician, nurse practitioner or physician assistant) use this form to records a patient’s medical diagnosis, medications, and assessment factors for daily activities. - New Mexico Department of Health Pre-Admission Screening & Resident Review (PASRR) Form (PDF)
Pre-Admission Screening and Resident Review (PASRR) is a federally mandated program that requires individuals, regardless of payment source, applying for admission to or residing in a Medicaid Certified Nursing Facility be screened for mental illness, intellectual disability or related conditions which affect intellectual functioning. Federal law prohibits payment for Nursing Facility services until the PASRR screening has been completed. The mandate applies to all individuals prior to admission to a Medicaid–certified long-term care nursing facility, regardless of payer.
Provider Contracting and Credentialing
- Contract Request Form
- Facility Credentialing Application (PDF)
- Address Change Form (PDF)
- Practitioner Termination Request (PDF)
- Behavioral Health Addendum (PDF)
- WSCC NM Roster Template (Excel)
- NM Bills4Nils Roster (Excel)
- Behavioral Health Credentialing FAQ Coming Soon
- Hospital – Facility Provider Application Coming Soon
- Ownership and Controls Disclosure Form Coming Soon
- Practitioner Data Form Coming Soon
- PDM Credentialing Checklist Coming Soon
- Sample Provider Agreements Coming Soon
- W9 Form Coming Soon
Provider Resources
- HEDIS Tip Sheets (PDF)
- CAHPS® Information - ways to enhance relationships with patients and improve CAHPS® scores Coming Soon
- NOP Form Training Video (YouTube)
Announcements
Manuals
Forms
Western Sky Community Care Forms
Medicaid
All Plans
- EXwD Education Letter (PDF) March 2022 (PDF)
- OB/GYN Incentive Flyer (PDF)
- Inpatient Prior Authorization Notice (PDF)
- NPPES Memo (PDF)
- Secure Provider Portal Enhancements (PDF)
- Home Health EVV Trainings (PDF)
- Career Development Initiative April 27, 2023 (PDF)
Medicare
- 2020 Medicare Prior Authorization Code Listing (PDF)
- Claims & Payment Policy: Leg Stent Coding Updates January 2022 (PDF)
- COVID-19 Medicare PHE Sunset Notice (PDF)
- Medicare Prior Authorization Change Summary Effective 10/1/23 (PDF)
Marketplace
Behavioral Health
COVID-19 Billing Guidance
Visit our Provider Coronavirus Information page for details and information on COVID-19 billing guidance.