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Provider Training

Provider Services is dedicated to building stronger relationships with our contracted healthcare providers/practitioners.

Office of Inspector General (OIG) Releases Health Care Provider Compliance Videos and Audio Podcasts
Click here to read the news release.

On December 6, 2011, the OIG posted on its Web site, the first of 11 short video and audio presentations for health care providers on top health care compliance topics.  Subsequent videos and audio podcasts will be released at the beginning of each week over a 3-month period (with no release the week of December 26). Daniel R. Levinson, HHS Inspector General, states, “We know that the overwhelming majority of health care providers are working hard to comply with Federal laws and regulations. These videos are designed to guide them in further enhancing their compliance efforts.” Click here to access the HEAT Provider Compliance Training Videos and Audio Podcasts.

You may also click on the image below to access the training.

OIG Provider Compliance Training at oig.hhs.gov

 

Click here to read the 2011 OIG Anti-Fraud Training, Additional Assistance provider communication

Missed our Webinar? (Recovery Of Claim(s) Overpayments Through The Explanation Of Payment (EOP))
On December 21, 2011, we held a live webinar that covered how to correctly post the recovery of claim(s) overpayments done through the explanation of payment (EOP).

*Please Note: Sound at the beginning of the recording is very low and is corrected 2 minutes and 42 seconds into the recording.

Pres Online Training Manuals for Physicians, Practice Managers and Staff

Pres Online Computer Based Training Modules for Practitioners/Physicians, Practice Managers and Staff
Pres Online instructional Web demonstrations are now available for providers and staff. Broken down by task, you can now review what instructions you want, when you want. Length of time in minutes and seconds for each demonstration is shown next to the link. Simply click on the link, sit back and watch the demonstration.

Recovery Of Claim(s) Overpayments Through the Explanation Of Payment (EOP) Training Manual
When Presbyterian recovers claim(s) overpayments through the EOP, please use this training manual to assist with posting the overpayment correctly when assistance is needed.  Terms also used for "claims overpayments" are "recoupment," "take back," and "negative balance."

Training Request Form
Please fill out this Training Request Form if you are interested in receiving specialized training from the Presbyterian Provider Services' Training Specialist. Our Training Specialist will review your request and contact you within 5 to 7 days of its receipt.

National Drug Code Procedure Manual
A 12/14/11 revision of the NDC Manual corrects instructions given with regards to correcting the omission of leading zeros in NDCs being entered on a claim form.

Medicare Advantage Annual Wellness Visit Documents

Cultural Sensitivity Competencies Offered Online With Up To 9 Hours of Free CEUs
Presbyterian Health Plan, Inc. and Presbyterian Insurance Company, Inc. (Presbyterian) are pleased to offer our network practitioners, providers, and nurse practitioners educational opportunities to become even more culturally competent while earning up to nine hours of free Continuing Education Units (CEU).

“A Physician’s Practical Guide to Culturally Competent Care” and "Culturally Competent Nursing Care: A Cornerstone of Caring" are continuing education activities. Supported by the Office of Minority Health at the United States Department of Health and Human Services, and accredited by Ciné-Med Inc., these online competencies are designed to assist healthcare professionals deliver culturally competent care to an ever increasing diverse population of members.

When you log on to Pres Online, a Cultural Sensitivity Competencies link appears directing you to the registration page www.ThinkCulturalHealth.hhs.gov.  You can also access the competencies by visiting www.ThinkCulturalHealth.hhs.gov.

During registration, you will choose an appropriate program in which to earn up to nine free CME credits (Physicians and Physician Assistants) or nine contact hours (Nurse Practitioners).

The website provides a Frequently Asked Questions section, which addresses everything from computer requirements to receiving your CEUs. Since these competencies are made available on the Internet, you can earn free CEUs at your convenience, 24 hours a day, seven days a week.

Advanced Imaging Ordering Program
View a Web demonstration for submitting an online Advanced Imaging Order request   (Flash 7 MB)

NOTIFICATION IMPORTANT INFORMATION: Chaves County Fluoride Varnish Project July 1, 2009
Presbyterian Health Plan is committed to ensuring that our practitioners and providers are kept apprised of changes that affect the way in which health care is administered, and changes in the benefits that members are offered. At the request of the New Mexico Human Services Department (HSD), Presbyterian Salud is participating in the Chaves County Fluoride Varnish Project.

The majority of children between newborn and three years (0 to 3) of age do not visit a pediatric or general dentist. Intervention during young childhood is important because cavity-causing bacteria can be established in an infant’s mouth by the time his/her first tooth erupts. For children at high risk of oral disease, this infection can quickly progress into rampant decay that can destroy a child’s primary teeth soon after they emerge. 

The Chaves County Fluoride Varnish Project, a pilot program, is a value added service allowing coverage of fluoride varnish application by Presbyterian Salud contracted, non-dental Primary Care Practitioners (PCPs) and Pediatricians located in Chaves County. As part of a child’s Well Child visit, PCPs and Pediatricians are being asked to participate in this pilot program because they see children before the child’s third birthday more often than a pediatric or general dentist.

Effective Date of the Chaves County Fluoride Varnish Program

  • July 1, 2009

Who is eligible to receive the fluoride varnish application?

  • The value added benefit will be available to Salud! members from newborn to a child’s third birthday (0 to 3 years of age).

Who is eligible to apply the fluoride varnish to members?

  • Chaves County PCPs, Pediatricians, and practitioners acting in the capacity of a PCP for children between the ages of zero and the child’s third birthday, who are contracted to see Salud! members.

Frequency of fluoride varnish application

  • Non-dental providers will be allowed to bill up to six applications for the noted members’ age range

 Coding and Reimbursement Information

  • Procedure Code: Please bill Presbyterian Salud for this service using procedure code D1206. 
  • Diagnosis Code: Please use diagnosis code V07.31 – Prophylactic Fluoride Administration, along with the appropriate Well Child diagnosis code.
  • Reimbursement: $15.00 per application.

Training
Providers are strongly encouraged to view the training provided in the Web links below to learn how to apply fluoride varnish to eligible members. Continuing Medical Education hours are offered through some of the training resources.

Ordering Fluoride Varnish for Your Office
NM HSD has offered the links below directing you to the companies that sell fluoride varnish: