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

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

Tobacco Cessation Benefits

Presbyterian recognizes the importance that quitting smoking plays in the overall health of our members. Tobacco cessation resources are being implemented and evaluated constantly to ensure that providers have the resources they need to help their patients stop smoking for good.

Our dedicated Quit Line is available 24/7 and may be reached at

or toll-free at . Individual tobacco cessation coaching is available with trained Presbyterian health coaches. These coaches provide support and review medications that help members stop using tobacco for good. Nicotine replacement therapies are also available, as are individual and group counseling.

Turquoise Care members have access to NeuroFlow, an online or mobile app that delivers nicotine cessation content and support. NeuroFlow is available at no additional cost and can be used on an unlimited basis. Members may sign up here.

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

Turquoise Care Provider Directories

Medication Therapy Management

Medication Therapy Management

Real-Time Prescription Benefits Tool

Behavioral Health

Behavioral Health Clinical Practice Guidelines

Last reviewed: 12/13/2023

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