2013 Practitioner and Provider Manual - Presbyterian Healthcare ...

Claims and Paymentat a rate of 2 percent for each month or portion ofany month on a prorated basis.Claims and Payment ResourcesmyPRESmyPRES is available 24 hours a day, seven days aweek and enables you and your office staff toobtain the following information electronically:If applicable, at-a-glance co-insurance, deductibleand out-of-pocket amounts (the member’sresponsibility and the amounts that have been metto date that are in our system at the time of inquiry)Other insurance information regarding the memberDetailed demographic information on the member’sprimary care providerInformation for finding a doctor, provider, or facilityCheck summaries (listing of EOPs that weremailed, with access to all claims associated withthat remittance including the address of where thecheck was mailed)Provider CARE UnitThe Provider CARE Unit was established to handlecomplex inquiries from providers, including webbasedinquiries, written inquiries, adjustmentrequests and telephone calls that were not resolvedthrough myPRES, Interactive Voice Response,http://www.phs.org, or one of our electronicsubmission vendors. The Provider CARE Unitaccesses myPRES when assisting you with yourinquiries. Please contact 505-923-5757 or 1-888-923-5757 for assistance.Mailing Address for Claims, Corrected Claims, andClaims ResubmissionsIn an ongoing effort to increase the timeliness ofprovider payment and maximum efficiency andresources in provider offices, Presbyterian stronglyencourages the use of electronic claimssubmissions. In the event that it becomesnecessary to submit a paper claim (new, resubmission,or corrected), please direct it to one ofthe following mailing addresses:Medical/Physical Health ClaimsPresbyterian Health PlanP.O. Box 27489Albuquerque, NM 87125-7489Behavioral Health ClaimsPresbyterian Health PlanP.O. Box 25926Albuquerque, NM 87125-25926Other Contact InformationCoding Information and ResourcesAmerican Medical Association (AMA) CPTProducts515 North State StreetChicago, IL 606541-800-621-8335https://commerce.amaassn.org/store/catalog/categoryDetail.jsp?category_id=cat1150004&navAction=jumpCenters for Medicare and Medicaid Services(CMS)http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/index.htmlProvider Updateshttp://www.cms.gov/Center/Provider-Type/All-Fee-For-Service-Providers-Center.html?redirect=/center/provider.asphttp://www.cms.gov/Regulations-and-Guidance/Regulations-and-Policies/QuarterlyProviderUpdates/index.html18-182014 Practitioner and Provider Manual - Ver. 3