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PHP Provider Services

Provider Training Request Form

Please fill out this Training Request Form if you are interested in receiving specialized training from Mark Sanchez, Presbyterian Provider Services' Training Specialist (505) 923-8066. He will review your request and contact you within 5 to 7 days of its receipt.

Provider Information (*required)

Provider's Name*:

Presbyterian Provider or Tax ID Number*:

Email Address*:

Telephone Number*:

Group Name (if applicable):

Name of Office Contact (if other than provider):

Title of Office Contact (if other than provider):

   
Training
*Type of Training Requested
  Appeals and Grievances
  Billing and Coding
  Contracting
  New PHP/PIC Benefit Plans
  PHP Policy and Procedure/Servicing
  Pres Online (member eligibility; claims status; member rosters; benefit certifications, submission and status; pharmacy exception, submission and status)
  Other:

*Description

Provide a detailed description of your training needs. If the training requested is product line specific, include product line(s) in your description.
*Delivery Method (select one)
  In Provider's Office : Number of Employees
  Telephone Conference
  Training Materials Only, send to my email address (provide delivery email address):
*Training Priority (select one)
  High (three weeks)
  Medium (two months)
  Low (four months)

Thank You

Note: Before submitting this form, print a copy and retain for your records. Once the Submit button is pressed, the form cannot be retrieved.