Presbyterian | Spring 2019 | Your Story

8 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. This means that Presbyterian must approve the service before you get it. Your primary care provider (PCP) or specialist will request your prior authorizations for you. Presbyterian does 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. MyRide application You can now schedule your non-urgent transportation online using your smartphone or home computer! Just register at https:// myride.superior-nm .com . After you log in, add the application as a shortcut to your smartphone to make it easier to log on later. You only need to update your information when it changes. Both Superior Medical Transportation (SMT) and Presbyterian Customer Service Center can help you with the application. They can also help you schedule a ride to your provider appointments if you don’t want to use the application. You can reach them at: Superior Medical Transportation (505) 923-6300 or 1-855-774-7737 Presbyterian Customer Service Center (505) 923-5200 or 1-888-977-2333 (TTY: 711 )