MedicaidAdministrativeLow impact
2024 November Network Connection
Presbyterian Health Plan·NM · Family Medicine, Internal Medicine, Pain Management +1 more·Provider News
We identified it
Nov 1, 2024
Summary
This is a Presbyterian November 2024 provider newsletter containing multiple informational updates and program announcements, including CAHPS survey preparation guidance, wellness program referral pathways, opioid use disorder pharmacotherapy treatment standards (180-day minimum), cybersecurity scam alerts, and preventive health resources. No billing code changes, coverage modifications, or prior authorization requirement changes are implemented.
Action Required
No immediate billing system changes required. For informational awareness: (1) Providers and front desk staff should be briefed on CAHPS survey talking points (scheduling access, specialist referral process) to optimize patient experience scores; (2) Billing team should be aware that opioid use disorder treatment claims should reflect minimum 180-day pharmacotherapy episodes per HEDIS POD measure standards, though this does not change current coding; (3) All staff should receive cybersecurity awareness training regarding scam alerts—do not process unsolicited payment requests from callers claiming to be regulatory officials; independently verify any such contact. Refer Presbyterian Medicaid patients to Path for Wellness programs via www.phs.org/PreventionProgram or 1-855-249-8587 as appropriate.