2013 Practitioner and Provider Manual - Presbyterian Healthcare ...

Table of Contents1. Presbyterian Healthcare Services ............................................................................................................... 1-1Purpose Statement .................................................................................................................................. 1-1Presbyterian Healthcare Services ............................................................................................................ 1-1Commercial Products .............................................................................................................................. 1-2Medicare Advantage: Presbyterian Senior Care (HMO)........................................................................... 1-2Presbyterian Centennial Care .................................................................................................................. 1-2Alternative Benefit Package ..................................................................................................................... 1-2Covered Services and Authorization:....................................................................................................... 1-3Regulatory Agency Websites ................................................................................................................... 1-32. Provider Network Management .................................................................................................................. 2-1What We Do ............................................................................................................................................ 2-1Keep Us Updated: Provider Change Notification Form ............................................................................ 2-1Expanding Contracted Services ............................................................................................................... 2-1Network Training and Education .............................................................................................................. 2-2Presbyterian’s Annual Conference for Health Care Professionals, Providers, and Staff ........................... 2-2Network Communications ........................................................................................................................ 2-2Provider Satisfaction Survey .................................................................................................................... 2-33. Primary Care Providers .............................................................................................................................. 3-1The Role and Responsibilities of the PCP ............................................................................................... 3-1Coverage Requirements and After Hours Care ........................................................................................ 3-2Requirement to Use Contracted Providers ............................................................................................... 3-2Laboratory Services ................................................................................................................................ 3-3Durable Medical Equipment (DME) Services ........................................................................................... 3-34. Specialists .................................................................................................................................................. 4-1The Role and Responsibilities of the Specialty Care Provider .................................................................. 4-1Requirement to Use Contracted Providers ............................................................................................... 4-2Laboratory Services ................................................................................................................................ 4-2Durable Medical Equipment Services ...................................................................................................... 4-2Specialty Care Provider Termination ....................................................................................................... 4-2Other Information for PCPs and Specialists ............................................................................................. 4-3Accessibility of Services Standards ......................................................................................................... 4-35. Preventive Health Care Guidelines ............................................................................................................. 5-1vii2014 Practitioner and Provider Manual - Ver. 3