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.
myPRES Training Manuals for Physicians, Practice Managers, and Staff
Annual Provider Education Conference
Presbyterian hosts an annual conference for all contracted providers and staff. The conference features updates on policies, procedures and initiatives. The 2013 conference included an orientation to the new state-funded Medicaid program, Centennial Care. If you missed our 2013 Centennial Care Orientation and Provider Training, you can view the recorded Web edition or read through the conference materials.
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.
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.
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.
Help Filling Out CMS 1500 and UB-04 Claim(s) Forms
The Centers for Medicare & Medicaid Services (CMS) website offers web-based training courses as well. Follow the links and instructions below for help navigating the CMS Website.
- Click on the "Web Based Training (WBT) Courses" link under "Related Links Inside CMS”
- For the CMS 1500 course, click on the "CMS Form 1500 (08/05) (July 2008)" link
- For the UB-04 course, click on the "Uniform Billing (UB)-04 - (July 2008)" link
Also available on the CMS website are helpful fact sheets that provide additional definitions, overviews, images of the claim forms, and more. Please find links below.
Contact your Provider Network Management Relationship Executive