2013 Practitioner and Provider Manual - Presbyterian Healthcare ...

1. Presbyterian Healthcare Services1. Presbyterian HealthcareServicesPurpose StatementPresbyterian exists to improve the health of thepatients, members, and communities we serve.Presbyterian Health Plan, Inc., and PresbyterianInsurance Company, Inc. (Presbyterian), are part ofPresbyterian Healthcare Services, New Mexico’slargest, locally-owned integrated health caresystem. Established on October 24, 1908, as theSouthwest Presbyterian Sanatorium, Presbyterianbegan as a treatment center and refuge fortuberculosis patients. Through the years,Presbyterian grew and expanded into the statewideintegrated health care system it is today. A few keyservices includeEight not-for-profit Presbyterian-operated hospitals,located in Albuquerque, Clovis, Espanola, RioRancho, Ruidoso, Socorro, and Tucumcari.The Presbyterian Medical Group, consisting ofmore than 500 physicians and practitionersproviding medical care throughout New Mexico.Presbyterian, New Mexico’s largest managed careorganization, providing commercial healthinsurance, Medicaid, and Medicare products.Presbyterian Healthcare ServicesPresbyterian offers a statewide health care deliverysystem that provides your patients and ourmembers with a comprehensive provider network, aquality medical management program, and costeffective,consumer-driven managed health careservices. We are committed to providingexceptional customer service to our providers andmembers. In all that we do, Presbyterian strives toensure members can access primary and specialtycare services as needed and receive quality healthcare services in the most cost-effective setting.Unlike most managed care organizations, whichare accountable to shareholders, Presbyterian isultimately accountable to a board of directorscomprised of volunteers from our communities.Presbyterian’s enduring purpose is to improve thehealth of the patients, members, and communitieswe serve.Our statewide network exists because of thepartnerships and relationships we build with you,our physical health, behavioral health, and longtermcare providers. Presbyterian’s statewidenetwork comprisesThirty-six general acute-care hospitals (eight ofthese are currently owned, leased, or managed byPresbyterian Healthcare Services)More than 10,000 practitionersMore than 300 retail pharmacies composed oflocally owned stores and most major chainsPresbyterian offers a range of health careinsurance products and programs to members,including commercial products, Presbyterian1-12014 Practitioner and Provider Manual - Ver. 3