Reference Guides

Tools & Resources

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.


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 InstructionsLow 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.


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 DirectoryPresbyterian 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: 5/4/2023

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 BenzodiazepineSAMHSA Treatment of Stimulant Use Disorders

Behavioral Health Reference Material

Centennial Care Behavioral Health Medical Necessity CriteriaMedicare and Commercial Behavioral Health Magellan Care Guidelines

Care Coordination

Behavioral Health Release of Medical Information and Coordination of Care FormCare Coordination FAQsReferral to Presbyterian Care Coordination, Case Management and Disease Management

Presbyterian Health Plan News & Updates

Find out about the newest staff and the latest technology, and all the other happenings at Presbyterian.

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