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2017 Member Handbook 12 7 - Presbyterian Healthcare …

2017 Member Handbook NTENNIALCARE. MPC111601 Centennial Care #930. Presbyterian Centennial Care 2017. Member Handbook Esta informaci n est disponible de manera gratuita en otros idiomas. S rvase llamar al Centro de Atenci n a los Clientes de Presbyterian al 505 923-5200 o al 1-888-977-2333 para obtener m s informaci n. Welcome to Presbyterian Centennial Care. We're proud to be your health plan. Our purpose is to help you improve your health. We will provide and coordinate your physical and behavioral health. We will also coordinate your long- term care services and support. You've taken a big step to make sure that you and/or your family has health coverage. This Handbook has important information to help you learn how to use your Presbyterian Centennial Care benefits. Please read it carefully. Such services are funded in part with the State of New Mexico. Provider Directory You can quickly access up-to-date information about providers by using myPRES.

Call Presbyterian Customer Service Center: Monday-Saturday, 7 am to 8 pm In Albuquerque (English and Spanish): 505-923-5200 Navajo/Diné in Albuquerque: 505-923-5157

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Transcription of 2017 Member Handbook 12 7 - Presbyterian Healthcare …

1 2017 Member Handbook NTENNIALCARE. MPC111601 Centennial Care #930. Presbyterian Centennial Care 2017. Member Handbook Esta informaci n est disponible de manera gratuita en otros idiomas. S rvase llamar al Centro de Atenci n a los Clientes de Presbyterian al 505 923-5200 o al 1-888-977-2333 para obtener m s informaci n. Welcome to Presbyterian Centennial Care. We're proud to be your health plan. Our purpose is to help you improve your health. We will provide and coordinate your physical and behavioral health. We will also coordinate your long- term care services and support. You've taken a big step to make sure that you and/or your family has health coverage. This Handbook has important information to help you learn how to use your Presbyterian Centennial Care benefits. Please read it carefully. Such services are funded in part with the State of New Mexico. Provider Directory You can quickly access up-to-date information about providers by using myPRES.

2 You can also view a copy of the latest directory on the Centennial Care page online at If you do not have a myPRES account, go to and look for the Register Now link in the myPRES login box. Follow the easy steps to create a login and password. More details about myPRES are listed in the next section. Call Presbyterian Customer Service Center: Monday-Saturday, 7 am to 8 pm In Albuquerque (English and Spanish): 505-923-5200. Outside of Albuquerque (English and Spanish): 1-888-977-2333. Navajo/Din in Albuquerque: 505-923-5157. Navajo/Din outside Albuquerque: 1-888-806-8793. TTY: 711. 4 Introduction You will no longer get a paper copy of the Provider Directory. If you do not have a way to access the Web or would like to receive a copy of the Provider Directory, please call the Presbyterian Customer Service Center at 505-923-5200 or toll-free at 1-800-356-2219. TTY users may call 711. Symbols You will see a few symbols in the Member Handbook to bring your attention to important information.

3 A reminder that the Presbyterian Customer Service Center phone numbers are at the bottom of each page in this Member Handbook . An alert that we need to hear from you. Information about whether you're required to provide a co-payment. What to do in an emergency. This alerts you to something of particular importance. Indicates a service that requires prior authorization. This means you need to get approval before you use the service. Some additional information you might be interested in. Call Presbyterian Customer Service Center: Monday-Saturday, 7 am to 8 pm In Albuquerque (English and Spanish): 505-923-5200. Outside of Albuquerque (English and Spanish): 1-888-977-2333. Navajo/Din in Albuquerque: 505-923-5157. Navajo/Din outside Albuquerque: 1-888-806-8793. TTY: 711. Introduction 5. myPRES. myPRES is a secure site that allows you to find and monitor a number of details related to your Centennial Care health plan.

4 Services Available through myPRES. Look up your benefit plan information Check your eligibility Complete your health assessment View your claims Ask for a new Centennial Care Member ID card Check on prior authorization requests Send a question to the Presbyterian Customer View your care plan if you are receiving Service Center care coordination services How to Register Follow these steps to register for myPRES. 1. Go to and click the REGISTER NOW). (Figure 1). Click here to register for myPRES. Figure 1. myPRES Registration Call Presbyterian Customer Service Center: Monday-Saturday, 7 am to 8 pm In Albuquerque (English and Spanish): 505-923-5200. Outside of Albuquerque (English and Spanish): 1-888-977-2333. Navajo/Din in Albuquerque: 505-923-5157. Navajo/Din outside Albuquerque: 1-888-806-8793. TTY: 711. 6 Introduction 2. When you click on REGISTER NOW, the myPRES Patient &. Member Registration page opens (Figure 2).

5 Figure 2. myPRES Member Registration 3. Complete the questionnaire. This includes creating a user ID and password that you will need to use when you logon to myPRES. Call Presbyterian Customer Service Center: Monday-Saturday, 7 am to 8 pm In Albuquerque (English and Spanish): 505-923-5200. Outside of Albuquerque (English and Spanish): 1-888-977-2333. Navajo/Din in Albuquerque: 505-923-5157. Navajo/Din outside Albuquerque: 1-888-806-8793. TTY: 711. Introduction 7. Presbyterian Customer Service Center If you have any questions about Presbyterian Centennial Care, the Presbyterian Customer Service Center can help you Monday- Saturday, 7:00 to 8:00 If you need help or have questions or concerns, you can call the Presbyterian Customer Service Center at one of the numbers below ( ). Presbyterian Customer Service Center Telephone Numbers Name Phone Number English and Spanish Inside Albuquerque: 505-923-5200.

6 Outside Albuquerque: 1-888-977-2333 (toll free). Navajo/Din Inside Albuquerque: 505-923-5157. Outside Albuquerque: 1-888-806-8793 (toll free). Deaf or hard of hearing TTY: 711. The table below lists some of the services that the Presbyterian Customer Service Center can help you with: Help Available Through Presbyterian Customer Service Center Help you find a PCP (Primary Care Help you with a medical or behavioral health Provider) problem or complaint Help you take your health assessment Help you with your Pharmacy (drug store/. (HA) prescription drug needs Tell you about your benefits (what is Help you with transportation needs covered and what is not covered). Tell you about community resources that Help you set up a myPRES account are available Help you connect with your care Help you find a peer support specialist coordinator Help you file an appeal or grievance Help you with translation or interpreter services Hear your feedback, concerns, and ideas for making our services better Call Presbyterian Customer Service Center: Monday-Saturday, 7 am to 8 pm In Albuquerque (English and Spanish): 505-923-5200.)

7 Outside of Albuquerque (English and Spanish): 1-888-977-2333. Navajo/Din in Albuquerque: 505-923-5157. Navajo/Din outside Albuquerque: 1-888-806-8793. TTY: 711. 8 Introduction You can also reach us by mail or email: Presbyterian Customer Service Center Box 27489. Albuquerque, NM 87125. The Presbyterian Customer Service Center email is We will respond to your email within 1 business day. You also can the call the Presbyterian Customer Service Center through myPRES, our secure Member website. To sign up for myPRES, go to our website, , and click Register now. Translation and Interpreter Services Presbyterian Centennial Care offers translation and interpretation services for more than 140 languages. Some of these languages are Spanish, Vietnamese, Portuguese, Russian, and American Sign Language. Our Customer Service Representatives speak English, Spanish, and Navajo/Din . When you call the Presbyterian Customer Service Center ( ), ask to be helped in the language you need.

8 You have the right to talk with your doctor or care coordinator in the language that you want. If you need help getting interpreter services with your doctor or care coordinator, call the Presbyterian Customer Service Center ( ). This service does not cost you anything extra. We also have written materials in languages other than English. We have written Member materials in other formats for members who are visually impaired or are not able to read. To ask for written materials in Spanish or in another language or format, please call the Presbyterian Customer Service Center ( ). You can also send an email to Presbyterian Customer Service Center representatives are available to help you read and understand your materials. Audio files are available upon request. Call Presbyterian Customer Service Center: Monday-Saturday, 7 am to 8 pm In Albuquerque (English and Spanish): 505-923-5200. Outside of Albuquerque (English and Spanish): 1-888-977-2333.

9 Navajo/Din in Albuquerque: 505-923-5157. Navajo/Din outside Albuquerque: 1-888-806-8793. TTY: 711. Introduction 9. A Quick Guide to Your Presbyterian Centennial Care Health Plan To help you get the care you need, please do these four steps: 1. Choose your Primary Care Provider (PCP). This is the Healthcare provider (for example, a doctor or nurse practitioner). who will take care of most of your health needs, and will refer you to another provider if needed. Read more about why you need a PCP on page 32 of this Handbook . To find a PCP: Look in the Presbyterian Centennial Care Provider Directory to find a PCP close to you. Look on our website, , and click on Find a Doctor for the most current list of PCPs. Call the Presbyterian Customer Service Center ( ) for help. The phone numbers and hours are at the bottom of each page of this Handbook . 2. Call the Presbyterian Customer Service Center ( ) if you need to continue medical care such as: x Case management x Long-term care services and x Home health services support x Medical equipment x Behavioral health care x Pregnancy care x Prescription drugs x Surgery that has x Other ongoing care (radiation, already been scheduled chemotherapy, dialysis, ventilator care, diabetes care, or pain control).

10 3. Keep your Presbyterian Centennial Care Member ID card in a safe place. Make sure to take it with you when you see a provider or fill prescription drugs. Your providers will ask for it at appointments. Call Presbyterian Customer Service Center: Monday-Saturday, 7 am to 8 pm In Albuquerque (English and Spanish): 505-923-5200. Outside of Albuquerque (English and Spanish): 1-888-977-2333. Navajo/Din in Albuquerque: 505-923-5157. Navajo/Din outside Albuquerque: 1-888-806-8793. TTY: 711. 10 Introduction 4. Take a health assessment (HA). Your HA will help us find out about your Healthcare needs and how we can help you stay healthy or get care coordination if you need it. See page 24 for more information on taking your HA. 5. Call your care coordinator for help, if you have one assigned. Your Healthcare coverage Your Presbyterian Centennial Care plan covers the benefits listed below. Make sure to read more about these services in Section two.


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