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July, 2010
Greetings!

I hope this message finds you well and successfully keeping up with how quickly summer seems to be flying by us all!
 
 
Please find below a brief list of important Neighborhood Health Plan (NHP) updates.
A New NHPNet!
We are pleased to inform you that we have completed the changes specific to our provider portal, NHPNet and Version 2.0 was made available on a pilot basis early this week.
 
The new NHPNet offers improved performance of some of NHPNet's current features in addition to new functionality (such as Claims Status Check and EOP downloading) plus a new look and feel consistent with our corporate image.  
 
Because of enhanced security allowing better management of role-based permissions, new and existing users must complete a quick one-time registration process before accessing the new provider portal. For User Administrators (those requesting to function in a user management capacity) evidence of approval to manage access and permissions for users associated with their provider entity is also required.
 
Feedback to date has been extremely positive. A full demonstration of all NHPNet features will be provided at our August Provider Operations Meeting, followed by full deployment this September.
NHP Honored for Outstanding Leadership in Environmental Asthma Management
Neighborhood Health Plan was recently awarded the National Environmental Leadership Award in Asthma Management by the U.S. Environmental Protection Agency (EPA).
 
The EPA designs public health programs to improve the lives of people with asthma. It partners with other Federal agencies and non-profit organizations to develop a national education and outreach initiative to increase public awareness and to make positive changes in the management of environmental asthma triggers. 
 
Part of the EPA's asthma initiative involves recognizing outstanding programs and leadership in community asthma care improvement. The National Environmental Leadership Award in Asthma Management  'celebrates the outstanding programs and leaders who are improving the lives of people with asthma by delivering strong environmental asthma management as part of their comprehensive asthma care services. NHP is one of only five programs to receive this award.
 
To read our press release and for additional information about this award, click here
 
NHP Provider Operations Meeting 
Our next meeting scheduled for Wednesday, August 11th
 
The agenda will include a demonstration of the new NHPNet and other provider self-service options, an overview of NHP's claims and member enrollment processes and other important information.
 
Two identical sessions are being offered for your convenience. To view the agenda and/or register for either of the morning or afternoon sessions, please click on the corresponding link:
 
 
  
Important Red Flag Rule Update for Health Care Providers
The Federal Trade Commission intends to agree to temporarily exempt health care providers from the FTC's Identity Theft Red Flags Rule.
 
The Red Flags Rule implements Sections 114 and 315 of the Fair and Accurate Credit Transactions Act. In relevant part, the Rule requires creditors and financial institutions that offer or maintain certain accounts to implement an identity theft prevention program.
 
The FTC had previously stated that health care providers could be deemed "creditors" under the Rule. The agreement will grant relief to health care providers until the resolution of litigation pending before the U.S. District Court for the District of Columbia, in which the American Medical Association and other health groups have asked the court to prevent the FTC from applying the rule to physicians.
 
The FTC has delayed enforcement of the Red Flags Rule until December 31, 2010, to allow Congress to take action to clarify the Rule's scope.   
Membership Update
As of June 30, 2010 we are 211,576 members strong!  
 
Additionally, under our new MassHealth contract effective July 1, 2010 MassHealth Essential and CommonHealth members now have the option to choose a Managed Care Organization such as NHP. As a result, more than 1,000 new MassHealth Essential members began receiving care through NHP since July.   
 
This growth is in addition to our full complement of health insurance programs for commercial members both through the Connector Authority's Commonwealth Choice program, as well as directly through our Business Choice products. NHP has experienced tremendous growth in commercial membership within these programs with approximately 7,500 new members since January, 2010.
 
We attribute this growth to significant recent expansions to ur provider network, as well as increased communication, education and awareness to individuals and small local businesses. We are eager to demonstrate to new and existing members the value of our services and our partnership with our valued providers.
         
Important Update for Patient-Centered Medical Home Initiative Applicants
We recently shared information regarding a multi-payer Patient-Centered Medical Home (PCMH) initiative for primary care providers. Selected applicants benefit by having the opportunity to participate in a three year transformation plan that includes:
 
  • Attending learning collaborative sessions
  • Working with medical home facilitators
  • Submitting patient registry-based reports
  • Applying for National Committee for Quality Assurance (NCQA) medical home recognition.
The Executive Office of Health and Human Services (EOHHS) have recently drafted new documents to assist providers with the application process. These include the following:
 
  1. The RFR Release Announcement...#157: provides highlights about the PCMHI design, and alerts providers about how to access the RFR
  2. The Payer PCMHI RFR Released Letter: a draft letter for payers to send to primary care providers about the PCMHI
  3. Comm-PASS Instructions for Providers: a document with specific instructions on how to access the RFR on Comm-PASS 
 
The following links provide detailed information about the PCMH initiative and corresponding deadlines, in addition to access to the newly published resources referenced above:  
 
MA Patient-Centered Medical Home Initiative
Harvard Vanguard Medical Associates Patient Referrals
 
A reminder that effective July 6, 2010, all NHP members with a Harvard Vanguard Medical Associates PCP will be required to obtain an appropriate referral from their PCP when seeking care from a non-Harvard Vanguard specialty provider. 
 
Referrals are not required for the following:
 
A Gynecologist or Obstetrician for routine, preventive, or urgent care
Family planning services provided by an NHP provider
Outpatient and diversionary Behavioral Health Services
Emergency services

NHP is making these changes to help enhance care coordination for those NHP members with a Harvard Vanguard primary care provider (PCP).
 
This referral requirement applies to Harvard Vanguard patients participating in all NHP plans: Commercial, Commonwealth Choice, Commonwealth Care, CMA, and MassHealth. Please note that for NHP members who are enrolled through the Group Insurance Commission (GIC), this change is effective for services rendered on or after September 1, 2010.
 
To avoid claims denials, providers should verify the existence of an appropriate referral for members with a Harvard Vanguard PCP prior to services being rendered.  
 
Those members affected by this change as well as the NHP provider community, have been notified of the new referral requirements. As always, please contact your Provider Relations representative directly with any questions or  our Customer Care Center at 800-462-5449.

 
New Provider Manual
Our online Provider Manual was updated as of July.Please visit our website often to learn about updates to this and other reference materials.  
 
Neighborhood Health Plan Provider Manual
  
Thank You! 
 
On behalf of the entire Provider Relations department and all of us at Neighborhood Health Plan, we thank you for the excellent care provided to our members and the continued collaboration extended to our staff.
 
Warmest Regards,
 
Ramona Bourguignon
Director, Provider Relations
Neighborhood Health Plan
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For all other questions, please contact the Provider Relations department at [email protected].