Our Vision:


© Copyright San Juan Independent Practice Association, 2018. All Rights Reserved.


Recent News: UPDATED 08/24/2018
  1. To ensure that a heath care delivery system is in place, which provides available, accessible and adequate numbers of facilities, locations, and personnel for the provision of health care services.
  2. To ensure that a health plan members are provided covered services without regard to race, color, creed, sex, religion, age, national origin, ancestry, marital status, sexual preference or physical or mental handicap.
  3. To ensure that the SJIPA has in place the organizational and administrative systems capable of messaging medical services contracts between providers and third party vendors
  4. To ensure that the quality of care to all patients continues at the highest level of  care possible.  
  5. Provide support for community health education and wellness.


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ALERT

All Presbyterian Contracted Members:  Presbyterian Announcement and contact information re:  UHC Centennial Member Transition


UnitedHealthcare Centennial Care Members Will Transition to Presbyterian Health Plan, Inc.







Presbyterian Health Plan, Inc. and Presbyterian Insurance Company, Inc. (Presbyterian) are committed to keeping providers informed of any changes that may affect their practice. We would like to announce that Presbyterian and UnitedHealthcare (UHC) reached an agreement to transition UHC Centennial Care members to Presbyterian Health Plan, Inc. (PHP) starting Sept. 1, 2018.
Many of these members are already served by PHP’s contracted providers, including our affiliated medical group, Presbyterian Medical Group (PMG), as well as other group practices and independent practices. This will help facilitate and ease the transition for members. In addition, PHP is pleased that it was able to hire a majority of UHC’s care coordinators in an effort to preserve these relationships with members.
 
Below are frequently asked questions to help providers and their staff understand how this transition may affect their practice.
 
Who is affected by this decision?
All current UHC Medicaid members will transition to PHP on Sept. 1, 2018. This transition applies to UHC Medicaid members only. PHP will mail new member ID cards to these members prior to the effective date. Please note that this transition does not include the UHC Dual Eligible Special Needs Plan (DSNP) product line.

What information will members receive regarding this transition?
Members will receive a joint letter from PHP and UHC in mid-August that will notify them of this transition.
 
What happens if a member presents a UHC health plan member ID card for Medicaid services after Aug. 31? 
Starting Sept. 1, 2018, UHC Centennial Care members with a UHC ID card are covered by PHP if they maintained their Medicaid eligibility. These members should have received a new PHP member ID card in the mail prior to Sept. 1, 2018.

If there’s a question about eligibility for a former UHC member, please call the Presbyterian Customer Service Center (PCSC) at 877-614-7447, Monday through Friday, 8:00 a.m. to 5:00 p.m. to verify eligibility and enrollment. Providers can also or verify member eligibility on the Presbyterian provider portal at
https://mypres.phs.org/Pages/default.aspx.
 
Where do I submit claims?
Providers should continue to submit claims to UHC for UHC Centennial Care members with dates of service up to and including Aug. 31, 2018. UHC will remain responsible for all medically necessary services rendered to members through Aug. 31, 2018 at 11:59 p.m. UHC will also remain responsible for all medically necessary inpatient services rendered to members hospitalized in an acute hospital as of Aug. 31, 2018, up to and including their date of discharge. Providers will submit claims with dates of service on and after Sept. 1, 2018 to PHP.
 
I’m contracted with both UHC and PHP. Is there anything I need to do in preparation?
No, providers who are contracted with UHC and PHP can continue to see UHC members who transition to PHP.

What should I do if I don’t know if our office is contracted with PHP?
You can verify your current PHP network contracting status by calling 505-923-8584, Monday through Friday, 8:00 a.m. to 5:00 p.m.

Who can I call if I have additional questions?       
Prior to Sept. 1, 2018, please contact UHC Provider Services at 888-702-2202, Monday through Friday, 8 a.m. to 6 p.m.
 
After Sept. 1, 2018, please call PCSC at 877-614-7447 for member questions and provider services at 505-923-8584 for provider questions, Monday through Friday, 8:00 a.m. to 5:00 p.m.
Thank you for partnering with us to improve the health of the patients, members and communities we serve. If you have any questions, please use the following information to contact your Provider Network Management relationship executive.







Provider Network Management
 

Hours: Monday through Friday, 8 a.m. to 5 p.m.

Phone: (505) 923-5141
Contact Guide: www.phs.org/ContactGuide

Mailing address: P.O. Box 27489, Albuquerque, NM 87125
Location: 9521 San Mateo Blvd NE, Albuquerque, NM 87113










 

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All San Juan IPA Members, Office Administrators & Managers Only:  Annual Membership Meeting (See attachment)

The San Juan IPA will be hosting our 2018 Annual Membership Meeting on Friday October 26, 2018 at 6:00 pm at the Buffalo Thunder Resort and Casino, Santa Fe, NM.  The meeting is for all San Juan IPA members and office managers/administrators only.  If you plan to attend please RSVP Heather DeLaBarcena at heatherd@sanjuanipa.com or call 505-564-7980 opt 1.


CME’s are available for all practitioner attendees (including anyone online). 


Meeting the Challenge:

Managing Difficult and Noncompliant Patients


-Presenters-


Senior Patient Safety & Risk Consultant, MedPro

Group and


Remo E. Gay & Associates, P.C.



Did you know?  The new Medicare numbers require new qualifiers, effective October 1, 2018.  Check with your software to make be sure they are prepared to change to the new qualifiers as of that date to avoid claim denials.  See attached link to the MLN from CMS websites. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10565.pdf



Member Login:

The San Juan IPA was founded in 1986 by a group of 21 community physicians to partner with

insurance companies with the goal of improving the quality of care to patients while simultaneously

decreasing the cost of care to those payers. Originally formed with a “Quality Assurance Committee”,

the San Juan IPA has grown to over 450 members representing 39 specialties and sub-specialties

in 70+ offices across New Mexico, a HEDIS quality review function, a Credentialing Committee,

and a care management committee component.


As an NCQA-accredited organization, San Juan IPA’s core services of contracting and

credentialing are complemented by an array of expanding resources for the physician office,

helping keep practice costs low and quality of care high.  We continually look for ways to

promote new quality initiatives both within and outside the practice walls for patients and employers.