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Presbyterian Health PlanAll Plans · Documentation · Provider News · NM · Family Medicine, Pediatrics, OB-GYN +2 moreMedium impact

2024 November Network Connection

Effective date
Not stated in the notice
Identified
Nov 1, 2024

Summary

Presbyterian's medical record review audit requires a passing score of 85% for primary care, OB/GYN, pediatric and high-volume behavioral health providers. Providers must document the status of advance directives for members 18 and older, and for members with diabetes they must document whether neuropathy screenings and retinal eye exams were completed or addressed. For preventive medicine services, new patient codes 99381-99387 and established patient codes 99391-99397 apply, and a significant, separately identifiable problem-oriented E/M service on the same day is reported with the office or outpatient code and modifier -25.

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What to do

Action · 10 steps
01Already effective Jan.
021, 2022: All providers must verify their directory information with Presbyterian every 90 days, and the source states there are no exemptions from this federal requirement.
03The deadline stated in this notice was Dec.
0427, so check current applicability before completing any past deadline.
05Physical health providers log in to the provider portal to make updates or request delegate access at www.phs.org/directoryupdate.
06Behavioral health providers log in to the behavioral health portal at www.magellanprovider.com.
07Providers must document advance directive status for members 18 and older, including education, declination, receipt or acknowledgment of the document.
08For members with diabetes, providers must document whether neuropathy screenings and retinal eye exams were completed or addressed.
09For preventive medicine visits, report 99381-99387 for new patients or 99391-99397 for established patients, and when a significant, separately identifiable problem-oriented E/M service is also provided, add modifier -25 to the office or outpatient code.
10If medical records fail to meet the 85% target, Presbyterian may recognize opportunities and advise providers of compliance concerns, suggest a performance plan, publish best practices, or coordinate a record review follow-up.

Codes mentioned

99381993879939199397992029920399204992059921199212992139921499215

Original notice

2024 November Network Connection
onbaseext.phs.org · Always check the source before changing claims.
View original ↗

Related policy hubs

Presbyterian Health Plan policiesNM policy changesFamily MedicinePediatricsOB-GYNInternal MedicineGeneral PracticeCode 99381Code 99387Code 99391Code 99397Code 99202Code 99203Code 99204Code 99205Code 99211Code 99212Code 99213Code 99214Code 99215

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