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Provider Manuals, Training & Outreach

 

Presbyterian is dedicated to building strong relationships with its contracted healthcare providers and practitioners. We offer training programs and information to keep up-to-date with current policies and procedures. Here you will find helpful tools designed to help with day-to-day interactions with members.

If you have any questions, contact your Provider Network Management Relationship Executive.

Manuals for Physicians, Practice Managers, and Staff

Annual Provider Education Conference

Presbyterian hosts annual conferences throughout New Mexico for all contracted physical health, behavioral health and long term care providers for all lines of business. The sessions feature updates on policies, procedures and initiatives of Presbyterian Health Plan. Please find the quarter one conference materials below and the recorded webinar.

Centennial Care Training

Through the myPRES Provider Portal, contracted providers with myPRES access can view a general Centennial Care Training and Centennial Care Cultural Sensitivity training under the Resources Links tab. If you do not have access to myPRES, you can request access by following the link below.

Request Access to myPRES

Electronic Visit Verification System

The Electronic Visit Verification (EVV) System is used to track and report home visits by Centennial Care personal care services provider agencies and caregivers. The EVV system allows Presbyterian and the long-term care provider community to better serve our members and ensure they are receiving the services they need.

For questions about using the EVV system, view the documents below or contact Provider Network Management, relationship executive, Orlando Gonzalez, at (505) 923-6205.

Cultural Sensitivity Competencies Offered Online

Presbyterian is pleased to offer our network educational opportunities to become even more culturally competent while earning up to nine hours of free Continuing Education Units (CEU). As you know, being culturally sensitive and competent is extremely important in healthcare – and especially in the state of New Mexico.

Continuing Education courses include:

  • A Physician’s Practical Guide to Culturally Competent Care
  • Culturally Competent Nursing Care: A Cornerstone of Caring

Supported by the Office of Minority Health at the United States Department of Health and Human Services, and accredited by Ciné-Med Inc., these online competencies are designed to healthcare professionals deliver culturally competent care to an ever-increasing diverse population of members.

During registration, you will choose an appropriate program in which to earn up to nine free CME credits (Physicians and Physician Assistants) or nine free CEU hours (Nurse Practitioners). Since these competencies are made available via the web, you can earn free CEUs at your convenience.

Register for CEU Classes

Recovery of Claim Overpayments

Presbyterian occasionally recovers claim(s) overpayments through Explanation of Payment (EOP). Presbyterian will pursue the recovery of claim(s) overpayments when identified by Presbyterian or another entity other than the practitioner, physician, provider, or representative. Other frequent terms used for claim(s) overpayments are: “recoupment,” “take back,” and “negative balance.” If you need assistance filing a recovery of claim(s) overpayment, please refer to the manual.

View Claims Recovery Training Manual

Healthcare Provider Compliance Videos and Podcasts

The Office of Inspector General (OIG) has several short video and audio presentations discussing compliance topics that are important to healthcare providers. The videos from the Health Care Fraud Prevention and Enforcement Action Team (HEAT) webcast are designed to guide healthcare providers in further enhancing their compliance efforts to help prevent fraud, waste, and abuse.

View Provider Compliance Training

Help Filling Out CMS 1500 and UB-04 Claim(s) Forms

For more guidance on filling out CMS 1500 (02/12) and UB-04 claims forms, you can refer to: