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Healthcare Professional and Provider Training

Provider Network Management is dedicated to building strong relationships with its contracted healthcare providers and practitioners. We intend to keep the relationships strong by continually keeping you informed through new trainings and information to keep up-to-date with current policies and procedures. Here you will find helpful tools designed to help with day-to-day interactions with patients.
 
 
Cultural Sensitivity Competencies Offered Online, gain up to Nine 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). As you know, being culturally sensitive and competent is extremely important in healthcare – and especially in the state of New Mexico.
Continuing Education courses include:
  • A Physician’s Practical Guide to Culturally Competent Care
  • Culturally Competent Nursing Care: A Cornerstone of Caring
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 healthcare professionals deliver culturally competent care to an ever-increasing diverse population of members.
To register for the CEU classes, log on to 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 free CEU hours (Nurse Practitioners). Since these competencies are made available via the web, you can earn free CEUs at your convenience.
Recovery of Claim(s) Overpayments through the Explanation of Payment Training Manual
Presbyterian occasionally recovers claim(s) overpayments through Explanation of Payment (EOP). Presbyterian will pursue the recovery of claim(s) overpayments when identified by Presbyterian or another entity other than the practitioner, physician, provider, or representative. Other frequent terms used for claim(s) overpayments are: “recoupment,” take back,” and “negative balance.” If you need assistance filing a recovery of claim(s) overpayment, please refer to the manual.   
 
National Drug Code (NDC) Procedure Manual
When submitting claims, Presbyterian requests that ALL practitioners and providers for all lines of business supply the 11-digit National Drug Code (NDC) when billing for injections and other drug items on the CMS1500 and UB04 claim forms as well as on the 837 electronic transactions. Please see the updated NDC Procedure Manual (.pdf) for reference.
 
Medicare Advantage Annual Wellness Visit Documents
Healthcare Provider Compliance Videos and Audio Podcasts
The Office of Inspector General (OIG) has several short video and audio presentations on its website discussing compliance topics that are important to healthcare providers.  The videos from the Health Care Fraud Prevention and Enforcement Action Team (HEAT) webcast are designed to guide healthcare providers in further enhancing their compliance efforts to help prevent fraud, waste, and abuse.
  
Help Filling Out CMS 1500 and UB-04 Claim(s) Forms
To help guide you in filling out CMS 1500 and UB-04 claims forms, you can refer to the “Claims” section of the Presbyterian's Provider Manual (page 111).  Instructional billing manuals are also listed below.
 
The Centers for Medicare & Medicaid Services (CMS) website offers web-based training courses as well. Follow the links and instructions below for help navigating the CMS website.
  • Click on the "Web Based Training (WBT) Courses" link under "Related Links Inside CMS”
    • For the CMS 1500 course,  click on the "CMS Form 1500 (08/05) (July 2008)" link
    • For the UB-04 course, click on the "Uniform Billing (UB)-04 - (July 2008)" link
Also available on the CMS website are helpful fact sheets that provide additional definitions, overviews, images of the claim forms, and more. Please find links below.