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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<strong>Presbyterian</strong> Customer Service CenterDo-not-resuscitate order. This lets membersinform caregivers they do not want to receiveCPR if their heart stops beating.<strong>Provider</strong> CARE UnitThe <strong>Provider</strong> CARE Unit is now a part of the PCSC<strong>and</strong> is designed to h<strong>and</strong>le “complex” inquiries fromthe provider community that cannot be resolvedthrough self-help options.Self-Help OptionsmyPRES is the quick <strong>and</strong> easy way of accessingreal-time information. This service is available 24hours a day, seven days a week to ensure that theinformation you <strong>and</strong> your office staff needs is atyour fingertips. This tool is your most efficient wayof getting the information you need when you needit.Each employee in your office that uses myPRESmust have their own individual user name <strong>and</strong>password. Under no circumstances should themyPRES user name <strong>and</strong> password be shared. It isyour responsibility to contact the PCSC to terminateaccess of employees who are no longer employed.If you have an employee who no longer requiresaccess to myPRES, please contact the PCSC toterminate their access.Violation of the terms <strong>and</strong> conditions for use ofmyPRES may result in revocation of myPRESaccess.Information available through myPRES includesMember eligibilityMember benefitsCo-payment, coinsurance, deductible, <strong>and</strong>out-of-pocket amounts (the member’sresponsibility <strong>and</strong> the amounts that have beenmet to date that are in <strong>Presbyterian</strong>’s systemat the time of inquiry)Information regarding a member’s otherinsurance (if applicable)PCP verification (including demographicinformation)Member rosters (for PCPs)Information regarding finding a doctor,provider, or facilityClaims status, inquiry, or verificationCheck summaries (listing of Explanation ofPayments that were mailed, with access to allclaims associated with that remittance,including the address of where the check wasmailed)Benefit certification submission <strong>and</strong> statusPharmacy exception submission <strong>and</strong> statusAccess to the <strong>Provider</strong> CARE Unit(electronically)<strong>Presbyterian</strong>’s Interactive Voice Response systemis available to assist you with member eligibilityverification, benefits, claim status, benefitcertifications, pharmacy exceptions, <strong>and</strong> behavioralhealth services.Web-based Inquiries<strong>Presbyterian</strong> may contact <strong>Provider</strong> NetworkManagement electronically by going tohttp://www.phs.org <strong>and</strong> selecting “Contact Us” fromthe menu at the bottom of the page, or by going to19-132014 <strong>Practitioner</strong> <strong>and</strong> <strong>Provider</strong> <strong>Manual</strong> - Ver. 3
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