New Mexico Application Service Provider Agreement

State:
Multi-State
Control #:
US-CP1027-AM
Format:
Word; 
Rich Text
Instant download

Description

This sample form, a detailed Application Service Provider Agreement document, is for use in the computer, internet and/or software industries. Adapt to fit your circumstances. Available in Word format.
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FAQ

A New Mexico Medicaid prior authorization form is a document used by medical professionals to request Medicaid coverage for a non-preferred drug. It's necessary to provide medical justification for not using a drug from the State-approved Preferred Drug List.

Note:Paper claims must be original claim forms; copies will not be accepted and will be returned.

Providers: Call Us. Customers: 1-800-283-4465. Providers: 1-800-299-7304. Email Us. Customers: NM.Customers@hsd.nm.gov. Providers: NM.Providers@hsd.nm.gov. Chat With Us.

If you are unsure if you or your organization are already enrolled in the New Mexico Medicaid program, please use the Provider Search tool to verify status. If you have any further questions or need assistance, please contact the Consolidated Customer Service Center (CCSC) at 1-800-299-7304.

If you continue to have problem accessing the chat icon call, Customers can call 1-800-283-4465 and Providers can call 1-800-299-7304. COVID19 Uninsured Group Coverage Is Ending on April 30, 2023. Click here for more information.

Centennial Care is the name of the New Mexico Medicaid program.

If you are unsure if you or your organization are already enrolled in the New Mexico Medicaid program, please use the Provider Search tool to verify status. If you have any further questions or need assistance, please contact the Consolidated Customer Service Center (CCSC) at 1-800-299-7304.

If you continue to have problem accessing the chat icon call, Customers can call 1-800-283-4465 and Providers can call 1-800-299-7304. COVID19 Uninsured Group Coverage Is Ending on April 30, 2023.

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New Mexico Application Service Provider Agreement