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Health | NMMIP Website

ANNOUNCEMENTS:

7/20/26: As part of our ongoing efforts to simplify and accelerate the prior authorization process, we are enhancing the Atrezzo Provider Portal by integrating InterQual® criteria directly into the submission workflow.

Today, prior authorization requests may require follow-up when clinical information is incomplete or does not clearly align with review criteria. This can lead to delays, additional administrative effort, and uncertainty around what is needed to support a timely determination.

With this enhancement, providers will be guided in real time during submission to include the clinical information and documentation required by InterQual criteria. This means:

• Fewer requests for additional information
• Reduced delays and faster authorization decisions
• Greater clarity on what is needed at the time of submission
• Less rework for provider office staff

By helping ensure requests are complete and aligned from the start, this integration enables faster, more predictable outcomes and a better experience for both providers and members.

Training resources for this feature are located under the "Provider Portal InterQual Enhancement" link of the Provider tab.

11/26/25: NMMIP has made changes to the prior authorization list. Select codes will now be automatically approved instead of requiring medical necessity review. Please refer to the codes list section under the Providers tab for further information.

12/20/24: NMMIP has made some changes to the prior authorization list. Please refer to the codes list section under the Providers tab for further information.

8/21/2024: There has been a shift in some administration of the Pool (NMMIP) that may result in a delay in claims processing. Please continue to provide services to our members and continue to use the Provider Login and Preauthorization Login below. Watch this website for further information and refer to this FAQ which will continue to be updated.

Please note that as of 4/1/24 Home Health Code G0158 will require authorization review and has been added to CPT list located on the Provider's tab.

Tips for locating members and reviews

If you receive the error "One or more procedure code does not require auth by Acentra Health" during case submission, please verify all of your CPT codes in the "CPT codes that require review" document located on the Providers tab of this website. If the code is present on the list authorization is required and a case can be submitted. If the CPT code is not present on the list, no authorization is required and the ANG system will not allow the code to be included in a case submission. Removing this code from your submission will remove the error and you will be able to continue your case.