Presbyterian Health Plan at a glance
| Legal name | Presbyterian Health Plan, Inc. |
|---|---|
| Also known as | PHP NM, Presbyterian Healthcare |
| Category | Commercial |
| Parent organization | Presbyterian Healthcare Services (nonprofit) |
| Claims payer ID | For Medicaid Turquoise Claims from March 23, 2026, Presbyterian specifies GS03 77048 via PROVIDERConnect or approved clearinghouses and NM109 NMPHP for approved clearinghouses. Legacy segment IDs are rejected in this Medicaid workflow; other products retain their established processes. Confirm the member product, service date and clearinghouse, not one universal payer ID. |
| Eligibility (270/271) payer ID | Stored eligibility references remain unverified for the current product and transaction. Claims identifiers do not establish 270/271 routing. |
| ERA (835) payer ID | 77039 — registry reference; verify the member product, transaction and clearinghouse. Not verified: Stored ERA references remain unverified for the current product, clearinghouse and enrollment. This claims comparison does not establish an 835 identifier. |
| NAIC company code | Not established in this registry |
| States covered | New Mexico |
| Members covered | ~580k members |
| Provider resource entry point | https://www.phs.org/providers |
| Provider phone | 1-505-923-5757Provider Care Unit handles claims, appeals and authorization at 505-923-5757 or 888-923-5757; the portal helpdesk is separate. |
Always verify claims-routing details against the member ID card and the payer's current EDI companion guide before submission.
Timely filing & appeals for Presbyterian Health Plan
This registry lists 90 days as an initial-claim reference for Presbyterian Health Plan. Confirm the applicable product, provider agreement, start event and current payer instructions. Do not apply this value automatically to out-of-network, secondary, corrected or appealed claims.
| Submission type | Window |
|---|---|
| Initial claim reference | 90 days (verify applicability) |
| Out-of-network initial claim | Verify the member's plan and applicable out-of-network rules |
| Secondary / coordination of benefits | Verify the allowed window and start event; a primary EOB does not automatically restart filing |
| Corrected claim | Verify correction instructions; do not substitute an appeal deadline |
| Reconsideration / appeal | Use the applicable denial or decision notice and the process below |
This registry has not established a payer-specific appeal ladder for Presbyterian Health Plan. Use the denial notice, plan document, provider agreement, or jurisdictional rule to assign the correct route and deadline. Missing registry evidence does not mean appeal rights are unavailable.
Source: Presbyterian Health Plan provider policy. Always confirm before disputing a TFL denial — payer policies are versioned and product-specific.
Prior authorization with Presbyterian Health Plan
Decision deadlines depend on the product, service and urgency. CMS-0057-F generally starts its decision-timeframe requirements in 2026 for Medicare Advantage, Medicaid and CHIP payers subject to the rule: seven calendar days for standard requests and 72 hours for expedited requests. Those requirements exclude drug authorizations and QHP issuers on the federally facilitated exchanges. Other plans, state rules and permitted extensions can differ. Check the applicable policy; a decision deadline is not a guarantee of approval.
CMS-0057-F decision-timeframe requirements and exclusions
Verify Presbyterian Health Plan electronic claims (837), eligibility (270/271), remittance (835) and authorization (278) separately for the member product and clearinghouse. Registry flags and routing references are not current transaction-complete approval. Confirm the companion guide, enrollment and applicable source findings below. A blank or unverified field does not establish that the transaction is unavailable. Authorization requirements and submission channels depend on the product, service and delegated reviewer. Verify the applicable policy before scheduling; a portal listing is not proof of X12 278 connectivity.
This registry does not provide a current prior-authorization code list for Presbyterian Health Plan. Start with the provider resources or the policy documents below, then confirm the applicable product, service and effective date. A resource link does not establish that a live code-lookup tool is available.
Top denial reasons for Presbyterian Health Plan
Per-payer denial benchmarks publish here once the QuickIntell anonymized ETL pipeline ingests sufficient Presbyterian Health Plan volume. Until then, see the broader CARC reference for industry-wide remediation guides.
Electronic claims, eligibility & ERA
| Transaction | Registry indication — not verification | Routing reference |
|---|---|---|
| 837P / 837I claims | Listed in registry; verify current scope | For Medicaid Turquoise Claims from March 23, 2026, Presbyterian specifies GS03 77048 via PROVIDERConnect or approved clearinghouses and NM109 NMPHP for approved clearinghouses. Legacy segment IDs are rejected in this Medicaid workflow; other products retain their established processes. Confirm the member product, service date and clearinghouse, not one universal payer ID. |
| 270 / 271 eligibility | Listed in registry; verify current scope | Stored eligibility references remain unverified for the current product and transaction. Claims identifiers do not establish 270/271 routing. |
| 278 prior authorization | Listed in registry; verify current scope | Verify X12 278 routing separately |
| 835 ERA | Verify support and enrollment separately | 77039 — registry reference; verify the member product, transaction and clearinghouse. Not verified: Stored ERA references remain unverified for the current product, clearinghouse and enrollment. This claims comparison does not establish an 835 identifier. |
Payer IDs vary by clearinghouse — confirm against your clearinghouse payer list (Availity, Change Healthcare/Optum, Waystar) before configuring submitter routing.
Source checks and remaining limits
The latest partial comparison is dated . Retained earlier findings keep their original dates below. This is a partial source check, not a whole-page, clinical or legal review. It does not refresh the legacy review date above.
provider_phone
Source comparison: 2026-09-26
Provider Care Unit handles claims, appeals and authorization at 505-923-5757 or 888-923-5757; the portal helpdesk is separate.
Primary source for provider_phonepayer_ids.claims
Source comparison: 2026-09-26
For Medicaid only, Turquoise Claims launched March 23, 2026 and rejects legacy payer/segment IDs. Presbyterian specifies GS03 77048 via PROVIDERConnect or approved clearinghouses and NM109 NMPHP for approved clearinghouses; other products keep their established processes.
Primary source for payer_ids.claims
Not checked in this pass: Whole-record approval, legal identity, ownership and complete product coverage; Authenticated transactions and QuickIntell integrations; timely_filing_days: No universal filing scalar established; verify the controlling plan, contract, jurisdiction and start event.; payer_ids.eligibility / payer_ids.era / era_payer_id: No transaction-specific universal eligibility/ERA identifier established; do not copy a claims ID.; electronic_claims_supported / supports_279_271 / supports_278: No blanket transaction-capability or QuickIntell connectivity certification; unauthenticated resources do not establish all stored flags.; appeal_levels / prior_auth_required_codes_sample / qi_module_coverage: No new approval of appeals, code-specific authorization or product integrations in this bounded pass..
Sources used for this guide
State coverage
Presbyterian Health Plan operates in the following states. Each link opens state-level Medicaid program details, dominant commercial payers, and state-specific RCM regulations.
Evaluate QuickIntell workflow fit for Presbyterian Health Plan
These module references are evaluation starting points, not evidence of a validated connection, supported transaction or customer deployment. Confirm the actual member plan, data access and product scope first.
- QuickRCM
Evaluate claim preparation, follow-up and denial worklists for Presbyterian Health Plan; verify the actual plan rules and available connections before implementation.
- QuickAuth
Assess authorization-packet and status workflows for Presbyterian Health Plan; confirm product, service, delegated reviewer and permitted submission channels.
- QuickERA
Verify the actual 835 files, posting exceptions and reconciliation requirements for Presbyterian Health Plan before evaluating automation. An ERA identifier alone does not establish supported ingestion or posting.
Frequently asked questions about Presbyterian Health Plan
Where is the Presbyterian Health Plan provider portal?
Use https://www.phs.org/providers as a starting point for Presbyterian Health Plan provider resources. This link may open a directory or contact page rather than a transaction portal. Select the applicable product and administrator, then verify the available functions, enrollment and access requirements. QuickIntell is not the official payer portal.
What is the timely filing limit for Presbyterian Health Plan?
This registry lists 90 days as an initial-claim reference for Presbyterian Health Plan. Confirm the applicable product, provider agreement, start event and current payer instructions. Do not apply this value automatically to out-of-network, secondary, corrected or appealed claims.
Does Presbyterian Health Plan publish a single claims payer ID?
This registry has not established one all-product claims payer ID for Presbyterian Health Plan. Claims: For Medicaid Turquoise Claims from March 23, 2026, Presbyterian specifies GS03 77048 via PROVIDERConnect or approved clearinghouses and NM109 NMPHP for approved clearinghouses. Legacy segment IDs are rejected in this Medicaid workflow; other products retain their established processes. Confirm the member product, service date and clearinghouse, not one universal payer ID.. Eligibility (270/271): Stored eligibility references remain unverified for the current product and transaction. Claims identifiers do not establish 270/271 routing.. ERA (835): 77039 — registry reference; verify the member product, transaction and clearinghouse. Not verified: Stored ERA references remain unverified for the current product, clearinghouse and enrollment. This claims comparison does not establish an 835 identifier.. Do not substitute a claims ID for an unverified transaction ID. Look up the correct ID for the member's plan and transaction in your clearinghouse directory and verify against the member ID card before submission.
Does Presbyterian Health Plan accept electronic claims?
Verify Presbyterian Health Plan electronic claims (837), eligibility (270/271), remittance (835) and authorization (278) separately for the member product and clearinghouse. Registry flags and routing references are not current transaction-complete approval. Confirm the companion guide, enrollment and applicable source findings below. A blank or unverified field does not establish that the transaction is unavailable.
How do I appeal a Presbyterian Health Plan denial?
This registry has not established a payer-specific appeal ladder for Presbyterian Health Plan. Use the denial notice, plan document, provider agreement, or jurisdictional rule to assign the correct route and deadline. Missing registry evidence does not mean appeal rights are unavailable.
How long do Presbyterian Health Plan prior authorization approvals take?
Decision deadlines depend on the product, service and urgency. CMS-0057-F generally starts its decision-timeframe requirements in 2026 for Medicare Advantage, Medicaid and CHIP payers subject to the rule: seven calendar days for standard requests and 72 hours for expedited requests. Those requirements exclude drug authorizations and QHP issuers on the federally facilitated exchanges. Other plans, state rules and permitted extensions can differ. Check the applicable policy; a decision deadline is not a guarantee of approval.
What is the Presbyterian Health Plan provider phone number?
This registry lists 1-505-923-5757 as a contact reference for Presbyterian Health Plan. Provider Care Unit handles claims, appeals and authorization at 505-923-5757 or 888-923-5757; the portal helpdesk is separate.
Automate workflows around Presbyterian Health Plan requirements
Connect eligibility, prior authorization, pre-submission claim checks, and remittance routing in one governed workflow. Payer and plan configuration is confirmed during implementation.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. Payer policies change without notice — always verify against Presbyterian Health Plan's current published documents before submission. CPT® is a registered trademark of the American Medical Association.