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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e-BusinessSimply visit the ePocrates ® web page, click on“EPOCRATES ONLINE” at the top of the page,sign in, <strong>and</strong> add formularies.<strong>Provider</strong> Network Management WebsiteVisit the provider page athttps://www.phs.org/providers/Pages/default.aspxto access useful information, documents, <strong>and</strong>forms, as well as to send online requests to<strong>Presbyterian</strong>.To access the provider pageGo to http://www.phs.orgSelect “For <strong>Provider</strong>s” at the top of the screenMedical Policy Information<strong>Presbyterian</strong>’s Medical Policy Committee (MPC)has the responsibility for creating, revising,interpreting, <strong>and</strong> disseminating benefit informationin a uniform <strong>and</strong> organized manner for use by<strong>Presbyterian</strong> employees <strong>and</strong> service partners. Aspart of this process, the MPC has created theMedical Policy <strong>Manual</strong> to assist in administeringplan benefits.The Medical Policy <strong>Manual</strong> is available on the<strong>Presbyterian</strong> website <strong>and</strong> is updated when new orrevised pages are approved by the MPC or theClinical Quality Committee. Not every <strong>Presbyterian</strong>plan contains the same benefits; therefore, themember’s contract must be reviewed before usingthe Medical Policy <strong>Manual</strong> to determine if a specificbenefit is available to a member.Information contained in the Medical Policy <strong>Manual</strong>does not replace the member’s Group SubscriberAgreement, Summary Plan Description, orEvidence of Coverage.To access the Medical Policy <strong>Manual</strong>, visithttps://www.phs.org/providers/cliniciansresources/medical-policymanual/Pages/default.aspx.Appeals <strong>and</strong> Grievances<strong>Presbyterian</strong> has implemented a verycomprehensive process, in conjunction with ourregulatory agencies, to ensure that our members<strong>and</strong> providers have a simple method to exercisetheir appeal <strong>and</strong> grievance rights. In order to makethis process as simple <strong>and</strong> effective as possible,you are able to file an appeal or report a grievanceby using our website. Should you wish to file anappeal or report a grievance, you may do so onlineat https://www.phs.org/providers/cliniciansresources/appeals-grievances/Pages/default.aspx.Click on the “Appeals <strong>and</strong> Grievances form” link. Ifyou are interested in learning more about appeals<strong>and</strong> grievances, please refer to the Appeals <strong>and</strong>Grievances chapter of this manual.17-62014 <strong>Practitioner</strong> <strong>and</strong> <strong>Provider</strong> <strong>Manual</strong> - Ver. 3
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