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Home|Providers|Clinicians' Resources|Health Services Resources

Health Services Resources & Forms

Presbyterian is pleased to provide this compilation of forms frequently requested by its healthcare providers. If you cannot find the material you need, please contact your Provider Network Management Relationship Executive.

Medical Policy Manual

Prior Authorization Guides & Forms (Contracted providers may submit their forms online through myPRES.)

Other Communications and Information

  • Asthma Toolkit

Forms

Preventive Healthcare Guidelines

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 for reference.

Medicare Advantage Annual Wellness Visit Documents

Presbyterian Health Plan, Inc. Resources

Forms & Documents

TriCore Reference Laboratories Information

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.

See HealthHelp for information about the company.

Tobacco Cessation Benefits Enhanced

Presbyterian has enhanced its tobacco cessation benefits for members with full medical coverage by allowing free enrollment in the Tobacco Quit Line. (Members enrolled on prescription coverage only plans are not eligible for participation.)

Your Presbyterian members 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 members 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.

New Mexico Medicaid Electronic Health Records Incentive Payment Program

Specifics of the Program for Eligible Professionals (State of NM Medical Assistance Division Document)

Medical Record Standards and Requirements

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 following documents:

Clinical Practice Guidelines

Asthma

Coronary Artery Disease

Diabetes

Obesity