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  • Nm Evicore Healthcare Drug Prior Authorization Request Form

Get Nm Evicore Healthcare Drug Prior Authorization Request Form

The state of New Mexico requires the use of this form for pharmacy prior authorization requests and UnitedHealthcare is posting it on their behalf for our providers. Fax form to: 8005402406.(6)* Patient.

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Contact support

You can also email us at portal.support@evicore.com, or reach us by phone at 800-646-0418, option 2.

The quickest, most efficient way to obtain prior authorization is through the 24/7 self-service web portal at .evicore.com. Prior authorization can also be obtained via phone at (888) 693-3211 or fax at (888) 693-3210.

If the level of review is an appeal you will receive a determination within the standard 30 days, or earlier based on state or federal requirements, as defined in the appeal rights of the initial decision notice. If you do not hear from eviCore within the standard 30 days, please call 800-792-8744, option 4.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232