About Us|Patients & Members|Health Plans|Hospitals & Clinics|Programs & Services|Doctors|Healthy Living|Careers

Healthcare Professional and Provider Resources

 About PHP Provider Services

The tools and information you find on this page will help you work more efficiently with Presbyterian and reduce the amount of time required for your administrative tasks.  If you have questions or problems, please contact the Provider CARE Unit at (505) 923-5757, between 8 a.m. and 5 p.m., Monday through Friday.
 

Provider Quick-link Resource Pages and Documents

Apply for myPRES Access
Presbyterian Health Plan's free myPRES Service (formally Pres Online) gives you access to updated information about claims, benefit certifications, eligibility, deductibles, exceptions and more. Please complete the myPRES for Presbyterian Health Plan Providers application to receive your username and temporary password.

Intel Connected Care Provider Directory
Please use this  provider directory to make referrals for Connected Care members or use the "Find a Doctor" tool and filter for Connected Care.

TriCore Reference Laboratories Information
TriCore Reference Laboratories Patient Care Centers Listing
2011 Non-Contracted Laboratory Letter

Physician Performance Assessments 
A Physician Performance Assessment is a report comparing the performance of you to your peers using patient severity risk adjusted Medical Episode Groupers (MEGs).  MEGs use age, gender and diagnosis codes to build a timeline of care for patients throughout their conditions.

The assessments  also use the three primary care specialties, including family practice, internal medicine and pediatrics, broken out by their topographical urban or rural location.  Urban locations include Bernalillo, Valencia, Torrance and Sandoval counties, and rural locations include all remaining counties in New Mexico.  The following are sample profiles for your reference:

Advanced Imaging Ordering Program
The documents below provide additional information about the Radiology Utilization and Cost program.  If you have questions or concerns about the program, please contact your Provider Network Management Relationship Executive.

SilverSneakers Fitness Program for Presbyterian Medicare Plans
The SilverSneakers Fitness Program provides your eligible Presbyterian patients with an opportunity to maintain their functional and mental health through physical activity programs.  The program includes a free basic membership to a network of fitness centers with access to all amenities and the signatures SilverSneakers group exercise class.  Please see the links below for additional information on the program.


Tobacco Cessation Benefits Enhanced
Prebyterian has enhanced its tobacco cessation benefits for members with full medical coverage* by allowing free enrollment in the Tobacco Quit Line.

Your Presbyterian patients who enroll in the Tobacco Quit Line program will receive up to five telephonic counseling sessions with specially trained counselors who will guide them through the quitting process.  As an incentive to enroll in and complete the program, the Tobacco Quit Line will provide a predetermined supply of nicotine replacement therapy products to patients who qualify.

Program Documents:

If you have any questions about this program, or would like to request additional information, please contact the  Presbyterian Tobacco Quit Line at 1-888-840-5445.
*Members enrolled on prescription coverage only plans are not eligible for participation.

New Mexico Medicaid Electronic Health Records Incentive Payment Program
Specifics of the Program for Eligible Professionals (State of NM Medical Assistance Div. Document)

 
Adaptive Skills Building: New Service Covered by Medicaid
The Medical Assistance Division (MAD) of the Human Services Department (HSD) , is offering Adaptive Skills Building (ASB) as a Medicaid covered service through OptumHealth New Mexico.  This very specialized service is for children up to 5-years of age that have been diagnosed with an Autism Disorder.  See documents below for information and assistance with becoming an OptumHealth New Mexico enrolled ASB provider.
Medical Record Standards and Requirements
Presbyterian Health Plan, Inc. and Presbyterian Insurance Company, Inc. (Presbyterian) must ensure that all members’ medical records are accurate and complete.  Presbyterian reports information to several regulatory and accreditation agencies including the National Committee for Quality Assurance (NCQA), the State of New Mexico Human Services Department (HSD), the Centers for Medicare and Medicaid Services (CMS), and the New Mexico Department of Insurance (DOI).  These agencies require that certain items be documented in every member’s chart.
A recent audit of Pediatrician and Primary Care Practitioner member charts showed opportunities for improvement in the following areas:
  • Documentation of any history of smoking, alcohol use, and substance abuse (for any member over the age of 12)
  • Documentation of past medical history
  • Documentation of medication history including what has been effective, what has not, and why.  This should include consistent documentation of refills, including long-term prescriptions such as asthma inhalers.  The history should also include any follow-up on new prescriptions.
Advance Directive documentation is required for all charts of adult members ages 18 and older.  This would include documentation that durable Power of Attorney and Advanced Directive information was provided to the member, and was signed and dated by both the member and the practitioner.  This documentation should also include if the member executed Advanced Directives.
 
If you have any questions about documentation standards, contact Jené Breitburg-Moya, RHIT, at (505) 923-5729 or jbreitbu@phs.org.  Additional information regarding chart documentation is available in the Presbyterian Provider Manual and also in the Medical Records Standards document.