2013 Practitioner and Provider Manual - Presbyterian Healthcare ...

Legalcontractual relationship with another managedcare organizationThe agreement with Presbyterian does notinclude any incentive or disincentive thatencourages you or any other subcontractornot to enter into a contractual relationship withanother contractorThe agreement with Presbyterian does notcontain any gag order provisions that prohibitor otherwise restrict covered healthprofessionals from advising patients abouttheir health status or medical care ortreatment as provided in Section 1932(b)(3) ofthe Social Security Act or in contravention ofNMSA 1978 §§ 59A-57-1 to 59A-57-11, thePatient Protection ActFor pharmacy providers, payments are beingmade consistent with 1978 NMSA § 27-2-16B,unless there is a change in law or regulationYou shall submit electronic claims, unless youhave been granted a hardship extension; theagreement with Presbyterian includes theHSD/MAD contractual provisions related tothe State of New Mexico Executive Order2007-049 concerning subcontractor healthcoverage requirements, as further defined inArticle 37You will comply with the State of NewMexico’s Statewide Immunization InformationSystem initiativeYou have not been restricted fromparticipating in a federal entitlement program(for example, Medicare or Medicaid)Exclusion from Federal Health Care ProgramsBy contracting to provide Presbyterian CentennialCare services, you warrant that neither you or youremployees, agents, or independent contractorshave, to the best of your knowledge, been excludedfrom participation in any federally funded healthcare programs, including but not limited toMedicare and Medicaid.You shall immediately notify Presbyterian if you orany of your servicing employees or subcontractorsare threatened with exclusion or excluded from anysuch program. In the event that you or yoursubcontractor are excluded from participation inany such program, Presbyterian may terminate theagreement as of the effective date of the exclusion.You shall immediately remove the excludedemployee or subcontractor from providing anyservices in connection with the agreement and shallnotify Presbyterian’s compliance officer in writing.In this notification you must state the informationknown regarding the basis for the exclusion and thesteps taken to remove the excluded persons fromproviding any services. If you cannot remove theexcluded employee or subcontractor, Presbyterianshall have the option to terminate your agreementas of the effective date of such exclusion. (Source:42 CFR § 422.752(a)(8).)Provider CommunicationsYou shall report to Presbyterian’s complianceofficer through telephone and follow-up electronicmail communication any suspected or potentialfraud or other misconduct by you, your agent, yoursubcontractor, or any other person or entity ofwhich you become aware.14-82014 Practitioner and Provider Manual - Ver. 3