What's New

2008 Provider Education Conference

Presbyterian Health Plan and Presbyterian Insurance Company, Inc. (Presbyterian) will hold the 2008 Provider Education Conference on Thursday, October 2, and Friday, October 3, 2008. Last year’s conference was a huge success! We want to give you plenty of time to make plans to attend this year. Participants choose to attend either the October 2 or October 3 session as information presented is the same on both days. The agenda is being finalized, but conference breakout sessions will include the following:

• Internal Medicine / Family Practice / General Practice / Pediatrics / Obstetrics/Gynecology
• Orthopedics / Podiatry
• Surgery
• Physical, Occupational and Speech Therapy
• Claims (including NPI information)
• Coding/Reimbursement

Our Medical Directors will participate in several of the breakout sessions and some of our business partners will be present so you can visit with them during breaks, lunch or after the conference. Watch for more information about the conference later this summer.
2008 Provider Education Reminder (.pdf)

Credentialing/Peer Review Committee 

Are you interested in serving on the Credentialing/Peer Review Committee?  The Provider Services and Quality Management Teams are seeking new members to serve on the committee that ensures Presbyterian Health Plan’s provider network is of the highest standard.  We are especially in need of representation for Behavioral Health, Cardiology, and Obstetrics/Gynecology specialties.

Committee members are reimbursed $100 per meeting and reimbursed for travel if from outside the Bernalillo County area.  If you cannot travel to Albuquerque, you may also conference into our meetings for active participation after an initial introductory visit to your first meeting.  Meetings are held the second Wednesday of every month from 6:00 p.m. to 8:00 p.m. at the Presbyterian Administrative Center, located at 2501 Buena Vista Drive SE, Albuquerque, NM.  Dinner is provided.

If you're a contracted Presbyterian Health Plan provider and wish to serve on the committee, please submit your letter of interest and curriculum vitae using the Credentialing/Peer Review Committee application.

If you have further questions, please contact Gloria Jett at gjett@phs.org or (505) 923-8276.

Apply for Pres Online Access

With Pres Online, providers can check patient eligibility, Primary Care Practitioner information, benefit plan details, claims status, request Benefit Certifications and Pharmacy Exceptions, and contact the Provider CARE Unit.  We're designing an automatice process to assign a secure Pres Online user and password when you meet set criteria, and expect to go live with this enhancement in 2008.  Until that is available, please do not use the "Register now" link in the Pres Online Login box.  Please complete the Pres Online for Presbyterian Health Plan Providers application to receive your login and temporary password within one business day.

 New Pres Online for Providers Web Training

Pres Online instructional Web demonstrations are now available for providers. Broken down by task, narrated, and averaging two minutes, you can now review what instructions you want, when you want. Click on PHP Provider Training under Quick Links to access the demonstrations.

New Product Information

As Presbyterian Health Plan and Presbyterian Insurance Company Inc. introduce new products, information for your review will be available on the PHP Provider Training Web page under Quick Links.  

Facets Upgrade in October

Due to a Facets System upgrade, there will be a delay of up to 120 days to bring on any new contracted providers.  We are working diligently to try to minimize any delays and shorten the length of time that you will be waiting for our decision and/or an executed contract.  If you have questions, please send an e-mail to PHPServices@phs.org. We apologize for the inconvenience and thank you for your understanding!

Radiology Cost and Utilization

Presbyterian Health Plan and Presbyterian Insurance Company, Inc. have partnered with HealthHelp, a radiology benefit management company, to manage the utilization of advanced radiology procedures for diagnosis of outpatient conditions.  HealthHelp provides ordering practitioners and offices with evidence-based clinical information, ("Medical Imaging Consultant" (MIC) booklet) and support needed to order CT, MR and PET scans with the goal of ordering the right procedure at the right time.

The MIC booklet is user-friendly, pocket-sized, based on current literature and best practice guidelines, arranged by symptoms and suspected clinical diagnoses, conveniently separated into children and adults sections, and is available in PDA format for hand-held devices.  Using the MIC to determine which test to order and submitting your request to HealthHelp online can result in approval in a few minutes.  Requests can also be submitted by phone or fax.  In complex clinical cases not adequately addressed in the MIC, and other cases, practitioners can speak directly to a HealthHelp specialty Radiologist.

Implementation of the Advanced Imaging Ordering Program started May 1st, 2007.  Details on using the MIC and submitting requests are available on the Provider Resources web page under "Advanced Imaging Ordering Program."

Visit the website for more information about HealthHelp.

View a Web demonstration for submitting an online Advanced Imaging Order request. (Flash, 7 MB) 

"NPI Only" As Of September 1, 2007

The Health Insurance Portability and Accountability Act (HIPAA) regulations established the National Provider Identifier (NPI) as the standard unique health provider identifier for healthcare providers and required all covered entities to comply with its provisions by May 23, 2007.

As of September 1, 2007, all claims now need to be submitted with the provider's NPI in addition to their federal tax identification number.  All claims submitted without the required information will be returned to the provider.  Therefore, effective September 1, 2007, all electronic and paper claims submitted to Presbyterian must be submitted with the provider's NPI and federal tax identification number only. Claims submitted without this information will be returned to the provider in the following ways:

• Electronic claims will be rejected back to the clearinghouse as not submitted with the required information. Providers will receive a rejection report from their clearinghouse with this information.
• Paper claims will be returned to the provider with a cover letter informing them of the reason and a request that they resubmit the claim(s) with the appropriate identifiers.

Presbyterian Provider CARE Unit
P.O. Box 25283
Albuquerque, NM 87125-5283