Health Services

Care Coordination is divided into 5 regions. We have assigned Care Coordination Assistants (CCA) to each region. The CCA is available to give you personalized attention to ensure that our members get the services they need. We are able to assist you with benefit certifications and coordinating care with specialists and out of plan providers. You may also contact us if a member requires longer term care coordination.

• Central Region (.pdf)
• Northeast Region (.pdf)
• Northwest Region (.pdf)
• Southeast Region (.pdf)
• Southwest Region (.pdf)
• Search by Zip Code (.pdf)

Medical Policies 

• Medical Policy Manual

Benefit Certification Requests

If you are a contracted provider:

• with access to the Internet and Pres Online, submit your Benefit Certification Request here. If your request meets the criteria necessary for that service, Pres Online will issue you an immediate certification approval
• and do not have access to the Internet or Pres Online, print the Benefit Certification Request Form (located under Forms (Printable) and fax them to the appropriate number
• Non- Contracted Providers who do not have access to the Internet or Pres Online need to print the Benefit Certification Request Form (.pdf) and then fax them to the appropriate number.

Unsure how to submit a Benefit Certification Request?  Here is a Benefit Certification Guide (.pdf) to walk you through it.

Online Care Coordination Assistance Request Form

• If you need assistance on an inquiry other than a Benefit Certification, you can now contact us using the Care Coordination Assistance Form. We will reply as soon as we have researched the issue/inquiry for you.

Other forms and Information

• Notifiable Diseases/Conditions in New Mexico

Recent Communications

• October 2008:   Certified Diabetic Educators Contracted with PHP (.pdf)
• March 8, 2007: New Fax Number for Benefit Certifications (.pdf)

Forms (Printable)

• Durable Medical Equipment (DME) Benefit Certification Request Form (.pdf)
• Inpatient / Outpatient Benefit Certification Request Form (.pdf)

Preventive Healthcare Guidelines (.pdfs)

• Presbyterian Health Plan Preventive Healthcare Guidelines
• Recommended "Done By One" Childhood and Adolescent Immunization Schedule - New Mexico, 2005

Clinical Practice Guidelines (.pdfs)

Asthma

• Guidelines for Diagnosis and Management of Asthma Summary
• Asthma Guidelines Full Report

Coronary Artery Disease

• Coronary Artery Disease Clinical Practice Guidelines 
• Coronary Artery Disease Clinical Practice Guidelines for Women
• ATP III 2004 Update
• Assessing Your Patient's Risk (Framingham Risk Score)
• Secondary Prevention Guidelines for patients with CAD/CVD

Diabetes 

• Diabetes Clinical Practice Guidelines for Providers - Non-Pregnant Adult 
  Diabetes Clinical Practice Guidelines for Members - Non-Pregnant Adult