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Medicare AdvantageCoverageMedium impact

2025 September Network Connection

Presbyterian Health Plan·NM · OB-GYN, Family Medicine, Internal Medicine +5 more·Provider News
Effective date
Sep 1, 2025
We identified it
Sep 1, 2025
Days to comply

Summary

Presbyterian has expanded breast cancer screening HEDIS measures effective immediately for Measurement Year 2025, lowering the recommended screening age from 50 to 40 years old and stratifying reporting by age groups (40-49 and 50-74). Providers should now recommend screening mammograms starting at age 40 for women at average risk. Additionally, Presbyterian is expanding its ophthalmology network in Q4 2025 and introducing new wellness programs, perinatal food benefits, and provider education requirements.

Action Required

Action needed
Immediately: Update clinical protocols and patient education materials to reflect new breast cancer screening age recommendation starting at age 40 (per USPSTF guidelines). Billing and clinical staff should be notified that screening mammography claims for women ages 40-49 will now be tracked separately in HEDIS quality reporting. Before Q4 2025: Verify that referral patterns include the newly expanded ophthalmology network providers (Eye Associates of New Mexico, Eye Institute of Albuquerque, Family Eye Care and Children's Eye Center of New Mexico, Juliette Eye Institute, Pacific Cataract and Laser Institute, Retina Consultants of New Mexico, Southwest Eyecare, Southwest Retina) for Medicare Advantage members. By September 12, 2025: All contracted providers must complete at least one Provider Education Conference & Webinar Series training (behavioral health or physical health based on specialty). Failure to comply may affect network participation. Document training completion. Optionally: Promote new wellness programs (Path for Wellness, NeuroFlow) and perinatal Food is Medicine benefit to patients during encounters to improve quality metrics and member satisfaction.