Health Services

Medical Policies 

• Medical Policy Manual

Prior Authorization Guide and Request Form

Prior Authorization Guide (.pdf) 
Prior Authorization Request Form (.pdf)
Diapers Prior Authorization Request Form (for Salud only) (.pdf)
Durable Medical Equipment (DME) Prior Authorization Request Form (.pdf)

Online Prior Authorization Requests (available to Contracted Providers only)

• Complete the PDF form electronically, print, and fax to appropriate number listed on the form.  OR
• Print the form, complete it manually, and fax to appropriate number listed on the form. Prior Authorization Request Form (.pdf) 

Referral Form: Care Coordination/Case Management/Disease Management (.pdf)
Durable Medical Equipment (DME) Prior Authorization Request Form (.pdf)
Inpatient/Outpatient Prior Authorization Request Form (.pdf)

Preventive Healthcare Guidelines (.pdfs)

• Presbyterian Health Plan Preventive Healthcare Guidelines
• Recommended Childhood and Adolescent Immunization Schedule-New Mexico
• CDC Provider Resource for Immunization Schedules

Clinical Practice Guidelines (.pdfs)

Asthma

• Guidelines for Diagnosis and Management of Asthma Summary
• Asthma Guidelines Full Report
• 2008 Asthma Change Page

Coronary Artery Disease

• Coronary Artery Disease Clinical Practice Guidelines 
• Coronary Artery Disease Clinical Practice Guidelines for Women
• ATP III 2004 Update
• Assessing Your Patient's Risk (Framingham Risk Score)
• Secondary Prevention Guidelines for patients with CAD/CVD

Diabetes 

• Diabetes Clinical Practice Guidelines for Providers - Non-Pregnant Adult

Obesity

• Obesity Clinical Practice Guidelines
• Adult Weight Counseling Discussion Guide
• Weight-Related Health Risk Worksheet