Forms & Other Resources for Members

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2440 Louisiana Blvd. NE,
Suite 601
Albuquerque, NM 87110

Customer Service:
1-855-769-6642

Sales: (505) 322-2360
Toll-Free: 1-855-808-3568
Sales Fax: 1-800-734-1596

Headquarters:
(505) 633-8020
Fax: 1-866-231-1344

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Member Forms & Other Resources

Below are forms that a True Health New Mexico member may need over the course of his or her membership with the plan.

¿Está usted buscando un formulario en español? Ellos encontrará en la página Formularios y otros recursos para miembros.

Forms

Appeal/Complaint Request Form & Assignment of Authorized Representative

Authorization to Release Protected Health Information (PHI)

Automated Clearing House (ACH) Form (for recurring monthly payments via bank draft)

Continuity of Care Form

Coordination of Benefits Form (Other Insurance Coverage)

Drug Prior Authorization Request Form (Give this form to your provider to complete and submit to us.)

Fraud, Waste, and Abuse Report Form

Healthy Check-Up Interview Form

Member Medical Claim Reimbursement Form

Member Pharmacy Reimbursement Form

Pharmacy Mail-Order Form

Subrogation (Accident/Injury) Referral Form

Transition of Care Form

Transplant Travel Benefit Description

Transplant Travel Expense Reimbursement Form

Where to Find Our Provider Directory

Visit our Online Provider Directory page

Need a paper copy of the Provider Directory? Please call us at 1-855-769-6642. We will mail one to your home. You also can send us a message online by clicking on the Contact Us link at the top of the page. However, please be aware that you can always find the most recent version of the Provider Directory on the page above. By the time you receive your paper copy in the mail, it is likely to be out-of-date.

True to Your Health, Our Member Newsletter

Fall 2018 issue

Summer 2018 issue

Spring 2018 issue

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