MedicaidAdministrativeHigh impact
2024 May Network Connection
Presbyterian Health Plan·NM·Provider News
Effective date
May 1, 2024
We identified it
May 1, 2024
Summary
Presbyterian has published a May 2024 provider newsletter containing multiple updates: (1) alternative claims submission methods and clearinghouses due to the Change Healthcare cyberattack affecting claims processing; (2) launch of the new PROVIDERConnect provider portal with streamlined eligibility, authorization, and claims search capabilities; and (3) updates to provider training requirements and new member incentive programs including the Pregnancy Passport program. The most critical item for billing teams is the immediate availability of alternative claims submission pathways to address ongoing Change Healthcare disruptions.
Action Required
IMMEDIATE ACTIONS REQUIRED: (1) Billing team must immediately identify which claims submission method the practice currently uses and confirm it is operational. If using Change Healthcare clearinghouse, activate alternate clearinghouse immediately—options include Availity (1-800-282-4548), Health EC (1-877-444-7194), Office Ally (1-866-575-4120), Payerpath (1-877-623-5706), TriZetto (1-800-969-3666), Claim.MD (505-757-6060), or Nthrive (678-323-2500). (2) Alternatively, billing staff must test FastClaim submission via mypres.phs.org portal using either direct entry or 837 electronic claims file upload. (3) All billing and administrative staff must be trained on the new PROVIDERConnect portal (mypres.phs.org) to access member eligibility, check authorizations, search claims, and download member handbooks—refer to PROVIDERConnect User Guide at https://onbaseext.phs.org/PEL/DisplayDocument?ContentID=OB_000000022172. (4) Clinical and administrative staff must complete required annual training: Provider Education Conference by June 28, 2024 (phs.swoogo.com/2024PEC); Behavioral Health Critical Incident Reporting by May 14, 2024 (phs.swoogo.com/bhcir24); Presbyterian Dual Plus training (phppn.org). (5) Front desk and billing staff should enroll in Lunch-and-Learn HEDIS sessions at phs.swoogo.com/valuebasedcarehub. FAILURE TO IMPLEMENT: Claims may experience delays, rejections, or denials if submitted through non-functional Change Healthcare channels; staff unable to access new portal functions will not be able to verify eligibility or check authorization status.