2013 Practitioner and Provider Manual - Presbyterian Healthcare ...
2013 Practitioner and Provider Manual - Presbyterian Healthcare ...
2013 Practitioner and Provider Manual - Presbyterian Healthcare ...
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Credentialing <strong>and</strong> Recredentialing17. e-Business17. e-BusinessCurrent e-Business Resources<strong>Presbyterian</strong> defines e-business as any tool orresource that allows information to be stored,displayed, or transmitted electronically. We strive tooffer online resources that save time <strong>and</strong> energy,<strong>and</strong> that provide our network with improvedefficiency resulting from immediate access tocurrent <strong>and</strong> accurate information. The following is alist of current <strong>and</strong> planned e-business toolsavailable to the network:myPRES: A password-protected portal(website) that allows your office to access avariety of <strong>Presbyterian</strong> resources, as well asmember, benefit, authorization, <strong>and</strong> claiminformationInteractive Voice Response (IVR) System:This system complements myPRES byproviding you access to member eligibility, copayment,<strong>and</strong> primary care practitionerinformation over the phoneElectronic Claims Transmission (ECT): Youcan save time <strong>and</strong> money by sending yourclaims electronically to <strong>Presbyterian</strong> throughone of our five contracted clearinghouses; alist of these clearinghouses can be found laterin this chapterElectronic Remittance Advice (ERA):InstaMed enables providers to receiveelectronic explanation of payments (EOPs)<strong>and</strong> fully reconciled remittances electronically<strong>and</strong> access a secure portal to view <strong>and</strong> printremittances at no costElectronic Funds Transfer (EFT): This enablesyou to receive <strong>and</strong> accelerate payments withEFT directly deposited into your existing bankaccount at no cost to you through InstaMedInstaMed: A third-party vendor of <strong>Presbyterian</strong>that provides you with an ERA/EFT system forelectronic transactions through a secure portalat no cost to providersHealthXnet ® : A third-party vendor of<strong>Presbyterian</strong> that provides you with access toa variety of information <strong>and</strong> functions over theinternet related to eligibility verificationOnline <strong>Provider</strong> Directory: For theconvenience of you <strong>and</strong> your patients,<strong>Presbyterian</strong> has improved its online providerdirectory by including information about ournetwork of primary care providers, specialists,<strong>and</strong> other providersePocrates ® : A web platform that allows theuser to access current <strong>Presbyterian</strong> formularyinformationThe <strong>Provider</strong> Webpage: The <strong>Presbyterian</strong>provider web page includes recentcommunications, benefit <strong>and</strong> criteriainformation, appeals <strong>and</strong> grievances, onlinesubmissions, <strong>and</strong> the online provider directory17-12014 <strong>Practitioner</strong> <strong>and</strong> <strong>Provider</strong> <strong>Manual</strong> - Ver. 3
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