Medical, Pharmacy & Behavioral Health

Presbyterian provides a compilation of forms and documents frequently requested by providers. If you cannot find the material you need, please contact your Provider Network Management Relationship Executive, or log onto the myPRES provider portal to submit your inquiry.

Medical

Preventive Health Guidelines

Preventive Healthcare Guidelines are evidence-based, systematically developed statements designed to provide practitioners and members with age-and gender-based recommendations about services that should be routinely incorporated into primary medical care. In considering individual member’s needs, please refer to member’s individual services/plans.

Presbyterian Health Plan has adopted the following Preventive Health Guidelines:

Adult and Children Preventive Services Practice Guidelines

• Affordable Care Act (ACA), Section 2713
• U.S. Preventive Services Task Force (USPSTF) Published Recommendations, Grades A&B
• New Mexico Human Service Department Medicaid Program, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services

Adult and Children Immunization Guidelines

• Centers for Disease Control and Prevention (CDC)
• Advisory Committee on Immunization Practices (ACIP)

TriCore Reference Laboratories Information

• TriCore Reference Laboratories Patient Care Centers Listing

Forms & Documents

• Fraud and Abuse Reporting Form
• Lab Submission Instructions
• Low Income Subsidy Pharmacy Information

Tobacco Cessation Benefits Enhanced

Presbyterian has enhanced its tobacco cessation benefits for members with full medical coverage by allowing free access to the Clickotine smartphone application. Clickotine provides personalized support that allows members to create their own quit-smoking plan and build habits necessary to overcome nicotine cravings. Choose a link below for more information.

• Clickotine Digital Application Patient Information (English)
• Clickotine Digital Application Patient Information (Spanish)

Members can also connect with a National Cancer Institute LiveHelp specialist and get immediate information and answers about quitting smoking. LiveHelp is available at 877-44U-QUIT (877-448-7848) from 7:00 a.m. to 7:00 p.m. Mountain time.

Pharmacy

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.

• National Drug Code (NDC) Procedure Manual

Pharmacy Forms

• OptumRx Mail Service

Centennial Care Provider Directories

• Centennial Care Provider Directory
• Presbyterian Centennial Care Network Pharmacy List

Medication Therapy Management

• Medication Therapy Management

Real-Time Prescription Benefits Tool

• Real-Time Prescription Benefits Tool Guide

Behavioral Health

Behavioral Health Clinical Practice Guidelines

Last reviewed: 12/09/2022

• Behavioral Health Practice Guidelines
• American Psychiatric Association Practice Guideline for the Treatment of Patients with Schizophrenia
• ASAM National Practice Guidelines for the Treatment of Opioid Use Disorder
• Behavioral Health Clinical Practice Guideline for Benzodiazepine
  
• SAMHSA Treatment of Stimulant Use Disorders

Behavioral Health Reference Material

• Centennial Care Behavioral Health Medical Necessity Criteria
• Medicare and Commercial Behavioral Health Magellan Care Guidelines

Care Coordination

• Behavioral Health Release of Medical Information and Coordination of Care Form
• Care Coordination FAQs
• Referral to Presbyterian Care Coordination, Case Management and Disease Management