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
U.S. Preventive Services Task Force (USPSTF) Published Recommendations, Grades A&B
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
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.
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.
Pharmacy Forms
Centennial Care Provider Directories
Medication Therapy Management
Real-Time Prescription Benefits Tool
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 Reference Material
Care Coordination
