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January, 2010
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Greetings!
January is flying by it seems but here we are, opening up a brand new year with a full agenda ahead of all of us. Here's wishing that the past few weeks have been productive, and reiterating that to the extent we are able, we remain committed to assist you in achieving those goals relevant to the population we jointly serve.
2010 will be forever remembered for the sadness and shock we've all experienced over the destruction and significant losses caused by the recent earthquake that hit the island of Haiti earlier this month. The situation in the aftermath of this devastating earthquake seems to be still unfolding with miracles along the way that lift our hopes of more to come, while sadly learning of increases in the death toll. Our thoughts and prayers are with the Haitian people, particularly with those members of our employee and provider community, as they cope with this event that has such devastated their nation.
Our Medical Director, Dr. Matt Collins, is currently in Haiti participating in the medical relief efforts with a team of volunteers from UMass Medical School. As we've seen in the news, Haitian clinicians are in short supply and the local hospitals and clinics were badly damaged by the earthquake. As a family physician, Dr. Collins has broad based skills to offer and we are extremely proud of him for this selfless act.
Please find below a brief list of important NHP updates.
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NHP Prior Authorization Process |
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| In our continuous efforts toward administrative simplification and in response to feedback from our provider satisfaction survey, we are currently exploring opportunities to further streamline the process for requesting prior authorization from NHP, including options for submitting these electronically through our NEHENNet partnership.
Additional information will be provided in the coming weeks as we finalize review of the identified opportunities. In the meantime, we welcome your ongoing feedback on how we can better serve you.
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Clinical Performance Improvement Initiative (CPII) Update
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As noted in our December message, each year, along with five other carriers that provide health insurance to the Commonwealth of Massachusetts Group Insurance Commission, we work collaboratively with the GIC and their consultants on the Clinical Performance Improvement (CPI) Initiative.
CPII involves aggregating a consolidated, multi-plan claims database (over 150 million claim lines) from all GIC carriers to construct quality of care and cost-efficiency profiles that are used for developing a tiered network. NHP tiers Primary Care Physicians at the group level and individually, practitioners specializing in Cardiology, Pulmonology, Gastroenterology, Rheumatology, Orthopedic Surgery, Endocrinology, Obstetric/Gynecology, and ENT/Otolaryngology.
NHP's tiered network only applies to GIC enrollees. The GIC plan design includes three tiers, with different office visit co-payment amounts assigned to each. Tier assignments do not affect NHP provider contract terms and/or reimbursement rates. Tier notifications were received by the network in early January and become effective July 1, 2010.
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Quarterly Hospital Admissions Reports (Update)
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We are still engaged in the testing required to provide options for making these paper reports available electronically via our provider portal, NHPNet. This transition will allow safer delivery of this sensitive data, while also giving the recipient the ability to manipulate the information in the manner that is most convenient.
The NHP Hospital Admissions Report contains data for Massachusetts acute care hospitals on the number of inpatient days for NHP enrollees (all product lines) who received services in the preceding calendar quarter.
We are aiming for a Q/2 implementation and additional details will be provided to current report recipients as we get closer to the implementation date.
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Website Updates
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- Our menu of Provider Payment Guidelines has expanded to include recent updates to several coverage and reimbursement policies. Be sure to visit the Policies and Guides section of our website regularly to review our most recent additions.
- An updated listing of contracted Durable Medical Equipment (DME) provider is now posted.
- Our website now features an option for visitors to sign up to join our "Provider E-News Community and receive these and other network updates. Check us out at www.nhp.org
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Upcoming NHP Provider Operations Meeting
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Our next quarterly Provider Operations meeting is scheduled for February 10th and as usual, we will offer two sessions (9:00 - 11:30 am OR 1:00 - 3:30 pm) for your convenience. We have important topics to share including a high level overview of CPII focused on administrative provider office staff (co-pay variations, etc), a presentation on the new HIPAA Red Flag regulations and the processes NHP will put in place to ensure compliance, plus other items including exciting raffle prizes!. Please encourage your staff to register on or before February 5th if at all possible so that we may plan accordingly.
We continue exploring regional alternatives in the very near future to accommodate participation from providers not able to travel to our Boston office. We hope to at least pilot this later in the year.
In the meantime, we thank you for your support in consistently sending representatives from your office. We value their contributions and interactive participation and use feedback collected through these meetings to improve how we do business with you.
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Thank You!
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On behalf of the Provider Relations department and all of us at NHP, thank you for your ongoing excellent care of our members and collaboration to our staff.
Best regards,
Ramona Bourguignon
Director of Provider Relations, Neighborhood Health Plan
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