Medical, Pharmacy & Behavioral Health
Presbyterian provides a compilation of forms and documents frequently requested by providers. If you cannot find the material you need, please contact your Provider Network Operations relationship team, or log onto the PROVIDERConnect Provider Portal using your myPRES credentials to submit your inquiry.
Medical
Preventive Health Guidelines
Preventive Healthcare Guidelines are evidence-based, systematically developed statements designed to provide practitioners and members with age-and gender-based recommendations about services that should be routinely incorporated into primary medical care. In considering a member’s needs, please refer to the member’s individual services/plans.
Presbyterian Health Plan has adopted the following Preventive Health Guidelines:
Adult and Children Preventive Services Practice Guidelines
U.S. Preventive Services Task Force (USPSTF) Published Recommendations, Grades A&B
Adult and Children Immunization Guidelines
Centers for Disease Control and Prevention (CDC)
Advisory Committee on Immunization Practices (ACIP)
TriCore Reference Laboratories Information
TriCore Reference Laboratories Patient Care Centers Listing
Forms & Documents
Fraud and Abuse Reporting Form
Tobacco Cessation Benefits
Presbyterian recognizes the importance that quitting smoking plays in the overall health of our members. Tobacco cessation resources are being implemented and evaluated constantly to ensure that providers have the resources they need to help their patients stop smoking for good.
Our dedicated Quit Line is available 24/7 and may be reached at (505) 923-5231 or toll-free at 1-866-742-7095. Individual tobacco cessation coaching is available with trained Presbyterian health coaches. These coaches provide support and review medications that help members stop using tobacco for good. Nicotine replacement therapies are also available, as are individual and group counseling.
Turquoise Care members have access to NeuroFlow, an online or mobile app that delivers nicotine cessation content and support. NeuroFlow is available at no additional cost and can be used on an unlimited basis. Members may sign up here.
Pharmacy
National Drug Code (NDC) Procedure Manual
When submitting claims, Presbyterian requests that all practitioners and providers for all lines of business supply the 11-digit National Drug Code (NDC) when billing for injections and other drug items on the CMS1500 and UB04 claim forms as well as on the 837 electronic transactions. Please see the updated NDC Procedure Manual for reference.
Turquoise Care Provider Directories
Medication Therapy Management
Real-Time Prescription Benefits Tool
Behavioral Health
Behavioral Health Clinical Practice Guidelines
Last reviewed: 04/08/2025
Behavioral Health Practice Guidelines
American Psychiatric Association Practice Guideline for the Treatment of Patients with Schizophrenia
ASAM National Practice Guidelines for the Treatment of Opioid Use Disorder
Behavioral Health Reference Material
Care Coordination
