Presbyterian | Spring 2020 | Your Story

www.phs.org/centennialcare 7 Prior authorization and Utilization Management We want to make sure you get the best care, in the right setting, at the right time. One way we help our members get the right care is with the prior authorization of certain healthcare services. Some healthcare services and medications need a prior authorization (an approval) from Presbyterian Health Plan (PHP). This means that PHP must approve the service before you get it. Your primary care provider (PCP) or specialist will request your prior authorizations for you. We do not reward or pay healthcare providers for not providing services or for not referring you for care. Your providers and Presbyterian staff members look at the following factors when making decisions about your care: • If the service or care is covered by your health plan • If the service or care is based only on your benefits and healthcare needs If you have questions about a prior authorization or Utilization Management, call our Presbyterian Customer Service Center. We can give you more information. We can also help you with language and translation services related to your questions. You can reach us at (505) 923-5200 or 1-888-977-2333 . TTY users can call 711 . To better meet your needs, a member of our Utilization Management team is available before and after normal business hours to help you. What is Utilization Management? The Utilization Management department manages the usage of certain healthcare services. They make sure that services are being used in your best interest and are safe. They review things such as certain imaging services, surgeries, emergency room use, and more. { { Presbyterian urgent care clinics offer same-day, scheduled appointments and walk-in visits depending on availability. To shorten your wait time, we recommend that you schedule ahead by phone or online at www.phs.org/urgentcare . { { You are covered for urgent care and emergency care services outside of New Mexico and worldwide. Just go to a nearby urgent care or emergency room and contact us if you have questions or concerns. More resources for getting care or medications Get help finding a provider. Call (505) 923-5200 and ask for the Member Advocate team. { { The Advocate team can assist with finding the right provider for you. Request a care coordinator. Call (505) 923-5200 or 1-888-977-2333 . { { A care coordinator works with your PCP and can help with your appointments and provide information about diet or medication treatment plans. { { A care coordinator can also connect you with local support and community resources to help you reach your goals. Talk to a Presbyterian Pharmacy Specialist. Call (505) 923-6790 . { { Our clinical pharmacists can work with your PCP to provide medication consultation or medication alternatives to help you save money. { { If you need financial help with your prescriptions, we may be able to connect you to financial support resources. Remember— you no longer have a prescription deductible.