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September, 2010
Greetings!

It is hard to believe that Fall is here already. I hope this message finds you well but busy no doubt as we all work on our various year-end deliverables.
 
 
Please find below a brief list of important Neighborhood Health Plan (NHP) updates.
NHPNet Access
Feedback from the network on our enhanced provider portal (NHPNet) continues to be extremely positive and most providers have already transitioned to the new version.
 
New users are automatically registered for the new version and we are currently completing the work of  phasing out the current version of NHPNet, scheduled for November.
 
All existing NHPNet Version I acccounts will be terminated as of November 15, 2010.
 
Users active as of November 1, 2010 will be notified by NHP of the need to create an account within NHPNet Version II prior to November 15th to ensure continued access.  
 
Please encourage staff to sign up for the new NHPNet now, particularly if there is no designated User Administrator on file with NHP for your provider entity, a requirement for all user access.
 
 
 
Access 90 Drug Program
Do you know about NHP's Access90 program?
 
Access90 allows NHP members taking medications on a regular basis to get up to a 90-day supply of certain prescription medicines as a convenience and in some cases, co-pay savings.
 
The program is voluntary and covers acid reflux, arthritis, asthma, depression, diabetes, heart disease, high cholesterol, high blood pressure and other drugs. Patients simply ask their doctor for a 90-day supply prescription when it is time for a refill. Patients starting a new medication must get a 30-day supply prescription the first time and a 90-day supply prescription the next time.
 
The associated patient copayments vary depending on the type of medication prescribed and the member's pharmacy coverage:
 
  • First Tier; Generic Drugs: two copays for 3 months supply
  • Second Tier; Brand Name Drugs: two copays for 3 months supply
  • Third Tier; Non-Preferred Brand Name: three copays for 3 months supply
 NHP's MassHealth Members pay only one copay for up to 90-day supply.
 
Access90 program is accepted at Louis & Clark Drug, Rite-Aid, Stop & Shop, Walgreens, Harvard Vanguard Medical Associates and many community health center pharmacies in addition to  independently-owned drugstores.
 
The NHP Drug Lookup option provides medication specific information covered by this program.
 
Please note that listed medications may be subject to a pharmacy step-therapy program or require additional authorization.
Patient Protection and Affordable Care Act
The Patient Protection and Affordable Care Act (PPACA) was signed into law this past March and includes numerous health care provider and insurer mandates such as the exemption of patient copayments (and deductibles) for select preventive care services. This specific change becomes effective October 1, 2010.
 
For new Commercial (including Commonwealth Choice) members enrolled in a new commercial plan with NHP on or after October 1, 2010 a provider copayment or a deductible for select preventive care and medical screenings is not required. For most existing NHP Commercial and Commonwealth Choice members, the copayment and deductible exemption begins for services rendered on or after January 1, 2011.
 
Additionally, effective October 1, 2010 members who are enrolled in a new commercial plan with NHP will no longer have an annual maximum on their Durable Medical Equipment (DME) benefit. For existing groups this will take effect on January 1, 2011.
 
Please note that this change does not affect NHP MassHealth or Commonwealth Care members.
 
NHP Commercial and Commonwealth Choice members are being notified of this change and encouraged to bring a copy of our notification with them when visiting their providers for a preventive care service as evidence of the new copayment exemption under the PPACA. 
 
Our claims processing system is also being modified to support this change. NHP offers various options for member eligibility verification, including our provider portal, NHPNet. Providers are strongly encouraged to verify eligibility at each encounter, including but not limited to while a member is hospitalized. Our Customer Care Center is also available to assist with questions at 800-462-5449.
 
Please visit our website at www.nhp.org for additional information on this new mandate and other important provider resources.
Provider Payment Guidelines
Please visit our website often for access to new and revised NHP Provider Payment Guidelines. To view the entire list of payment guidelines click here.
 
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].