Resources

Clinical Criteria

Our evidence based Clinical Criteria can be accessed at the following URL: Stanson Health Clinical Criteria

Copies of our Clinical Criteria are available upon request. To request a copy of our Clinical Criteria, please call us at 1-888-216-7010. Thank you.

Provider Resources

Elderplan Elderplan Covered Services List View Elderplan Physician Quick Reference Guide View Elderplan Prior Authorization Fax Form View Facility Credentialing Application View Physician Credentialing Application View CenCal CenCal Covered Services List View CenCal Physician Quick Reference Guide View CenCal Prior Authorization Fax Form View IUHP Care to Care Provider FAQ View Covered Services List View Physician Quick Reference Guide View Prior Authorization Fax Form View Presbyterian Health Plan New Mexico Authorization Requirements and Clinical Criteria A. Prior Authorization of Non-Urgent Healthcare Service (NMAC 13.10.31.8) PHSI acting on behalf of the Health Plan must make an authorization or non-authorization determination within the below timeframes: NM ST § 59A-22B-5 7 business days upon receipt of necessary information otherwise it is deemed approved. 24 calendar hours from request for expedited cases otherwise deemed approved. Any written clinical criteria can be found on: Stanson Health Clinical Criteria For Presbyterian Health Plan, Inc and Presbyterian Insurance Company, Inc. only: Presbyterian utilizes the Uniform Prior Authorization Form pursuant to the New Mexico Administrative Code (NMAC) 13.10.31.10. The form may be found here.   CarePortal Prior Authorization Request Demo Video View CarePortal Registration Demo Video View CarePortal User Guide View Radiology Benefit Management Frequently Asked Questions View Radiology Benefit Management Quick Reference Guide View Utilization Review Matrix View