Medicare AdvantageAdministrativeHigh impact
2026 September Network Connection
Presbyterian Health Plan·NM · Psychiatry, Dermatology·Provider News
Effective date
Oct 1, 2026
We identified it
Sep 2, 2026
Summary
Presbyterian is expanding virtual care offerings (VirtualPRES) including Virtual Medication Management and Virtual Dermatology, implementing a 90-day provider directory verification requirement with removal from directories beginning October 1, 2026 for non-compliant providers, and transitioning dual-eligible members from HMO D-SNP to Fully Integrated Dual Eligible Special Needs Plan (FIDE D-SNP) in 2027. Additionally, Presbyterian is promoting the Path for Wellness Healthy Weight Program and New Mexico Tobacco Quitline as covered member services, and providing education on accurate billing of psychotherapy add-on codes and well-care visit timing.
Action Required
REQUIREMENTS:
By September 30, 2026: All physical health and behavioral health providers must complete directory attestation in their respective portals (provider portal for physical health providers; behavioral health portal for behavioral health providers). Failure to complete attestation by this deadline will result in removal from public provider directories (online and printed) beginning October 1, 2026, with continued non-compliance subject to contractual compliance review and applicable remedies.
Action Items:
- Billing team/Provider relations: Verify all contracted providers have completed 90-day directory attestation
- Physical health providers: Log in to provider portal at scheduled intervals to update directory information; contact providerdemo@phs.org for issues
- Behavioral health providers: Log in to behavioral health portal; contact PHPTCBH@magellanhealth.com for issues
- Update internal tracking system to flag any providers removed from directories as this may affect claim routing and patient referrals
Ongoing (for 2027 transition): Providers should prepare for transition of dual-eligible members from Presbyterian Dual Plus (HMO D-SNP) to FIDE D-SNP in 2027. Continue following current eligibility verification, appeals, and grievance processes. Expect future integrated member ID cards showing both D-SNP and Turquoise Care numbers. No provider action required at this time, but monitor for further communications regarding integration implementation.
Educational: Train billing and front desk staff on Presbyterian's virtual care offerings (VirtualPRES) to support patient education and referrals. Ensure staff can direct patients to phs.org/virtualcare for self-scheduling Virtual Medication Management and Virtual Dermatology appointments.