New to True Health New Mexico?
Welcome! We are happy to have you as a member. We know that health insurance can be confusing, so in addition to the information you have received in the mail, we have collected some resources that should help you get the care you need from us.
If you have a general question, you may call Customer Service toll-free at 1-844-508-4677 or send us a message online.
- Looking for your New Member Guidebook? View and download it here. Federal employees, your New Member Guidebook is here.
- Looking for a provider in our network? Our network of providers is over 10,000 and growing and includes providers in west Texas. Search our online provider directory.
- Need to choose a Primary Care Provider (PCP)? We urge you to choose a PCP as soon as possible, if you don’t already have one who is in our network. Learn why and how to choose one.
- Want to find out if the medications you take are covered by your plan? Learn more about your pharmacy benefit and view our Formularies (list of covered medications) on our Pharmacy page.
- Currently receiving care from a provider who is not contracted with True Health New Mexico? You should complete and submit a Transition of Care form.
- Need help managing your asthma or diabetes? We offer disease management programs at no extra cost to you. We’ll help you understand your condition, improve your quality of life, and keep your medical costs under control. Learn more on our Disease Management Services page.
- Have complex health needs? Our Case Management Program will help you coordinate your healthcare services; communicate with your providers, caregivers, and family members; and guide you to the most appropriate care for you – at no extra cost. Find the details on our Case Management Services page.
Want to ask a non-urgent health question of an experienced registered nurse? The True Health New Mexico Care Connect Line is a service available exclusively to members and their eligible dependents. This nurse advice line is staffed 24 hours a day, 7 days a week, 365 days a year to help you decide what action to take for your non-life-threatening injury or illness. Call 1-844-308-2552 toll-free.
Want to give your spouse or other family member access to your protected health information (PHI)? Health care providers and True Health New Mexico may discuss your PHI as necessary to do their jobs, but they may not disclose your information to other people outside of the bounds of treatment, payment, or healthcare operations without your authorization. This includes releasing information to a spouse, child, or anyone you designate. An Authorization to Release Protected Health Information form must be completed and signed by you, the member, to release your Protected Health Information to them. You can find the form on our Member Forms & Other Resources page. Complete and sign the form and follow the instructions on the form to return it to us.
We want to work with you to find out your specific health needs and guide you to as many True Health New Mexico health services and providers you may need. We need your help in setting the plan for your health. Please complete our brief Healthy Check-Up questionnaire and click Done at the bottom to send it securely to us.
Looking for Your ID Card?
The high volume of enrollment activity we sometimes experience can cause delays in ID cards being mailed to our new members. We apologize for any delays you might be having.
At this time, once your enrollment data is loaded into our system, it takes approximately 10 business days for you to receive your ID card in the mail. This means that if your effective date is the first of the month, you may not receive your ID card(s) until after the tenth of that month.
If you need access to your ID card right away, you can log in to our secure member portal to view and print a temporary member ID card. You may also download the True Health New Mexico mobile app to view and print your ID card. You will find links for the mobile app on the member portal login page.
Do you need help registering or logging in to the member portal, or using the mobile app? Call Customer Service toll-free at 1-844-508-4677.
Thank you for your patience and for being a member of True Health New Mexico.
Our Utilization Management Procedures
Utilization management (UM), sometimes called utilization review, is the evaluation of the medical necessity, appropriateness, and efficiency of the use of healthcare services, procedures, and facilities under the provisions of your health plan.
- Most routine services, such as a visit with a PCP or specialist, do not need a prior authorization (PA). You usually need a PA for certain procedures or surgeries, exceptions to the formulary (drug list), and requests for services outside of our provider network.
- When you do need a PA, your provider makes the request for you. The PA process can take place before the service occurs in planned and non-urgent situations, at the time of an urgent situation, and after receiving care.
- If you are admitted to a hospital, the facility must tell True Health New Mexico. It is up to you and your provider to see that all PA procedures outlined by True Health New Mexico are followed correctly. (These procedures are in your Evidence of Coverage/Member Handbook – see our Individual Plan Documents, Small Group Plan Documents, or Large Group Plan Documents pages.)
- When a PA is required, True Health New Mexico uses doctors who are licensed in New Mexico to conduct the reviews and to make determinations (decisions).
- True Health New Mexico nurses review all inpatient services as they occur to ensure that you are receiving the best service for your level of care.
- We offer case management services to True Health New Mexico members who have complex healthcare needs. This ensures that you receive appropriate and timely care.
- We also offer transition-of-care services for up to 30 days. These services are for when you are being treated by a non-contracted provider at the time of your True Health New Mexico enrollment.
- Find complete utilization management information in your Member Handbook.