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December, 2010
Greetings!

I hope this message finds you well  and caught up on your holiday shopping!
 
Please find below a brief list of important Neighborhood Health Plan (NHP) updates.
 Durable Medical Equipment Coverage Changes

Over the last few months we've been sharing with you changes affecting how we do business as a result of the Patient Protection and Affordable Care Act (PPACA), including the elimination of limits to covered essential health care benefits.

 

NHP considers Durable Medical Equipment (DME) to be an essential health care benefit as defined by this new regulation and therefore will be removing the current calendar year limit. This change applies to all NHP Business Choice HMO and Commonwealth Choice plans within our Commercial line of business and is effective January 1, 2011.  Custom plans will change upon renewal.

 

To minimize premium increases after these DME coverage limits are removed, NHP is adding a 20% coinsurance to the DME benefit.  This change is effective April 1, 2011, and also applies to most standard Business Choice HMO and Commonwealth Choice plans as noted above.

DME coverage varies by specific plan. Additional plan specific information is available via our website at www.nhp.org . For member specific or any other questions please contact our Customer Care Center at 800-462-5449.


Online Prior Authorization Request Submissions

We are pleased to announce that a new provider option for submitting prior-authorization requests to NHP will soon be available!

 

This option allows direct authorization submissions (278) as an alternative to submitting these via paper. Online authorization submissions is also available to providers currently using NEHEN to submit authorization requests to other payors.

 

For additional information, please email us at prweb@nhp.org. A representative will follow up with responses to general and/or provider specific inquiries.

   Inpatient Admissions Coverage Changes

As a follow up to our recent letter, for hospital admissions on or after December 1, 2010 NHP no longer covers acute inpatient stays after the first 20 days for MassHealth enrollees 21 years of age or older. 

Coverage remains unchanged for all medically necessary inpatient stays for services provided:

  • in a Department of Mental Health (DMH) licensed acute psychiatric unit
  • within a Department of Public Health (DPH) licensed acute hospital
  • in a rehabilitation unit within a Department of Public Health licensed acute  hospital

This change applies to NHP's MassHealth product only and does not apply to administrative days.

As always, our Customer Care Center is available to address any questions and can be reached at 800-462-5449.

 Smart Neighbor Provider & Member Resource

Did you know that NHP maintains a "directory" of non-medical provider sources?

 

NHP's Smart Neighbor provides information to members and providers about community programs, social services, and other relevant public benefits and resources.

 

In addition to members, many providers also use this resource. Whether assisting patients with finding employment services for individuals with disabilities, looking for information about local food pantry and meal programs or verifying regulations that govern the education of children with special health needs, Smart Neighbor is a good place to start! 

 

Click here to learn more. 

New Publication Schedule for NHP's monthly "Provider News"
 

A reminder that beginning in 2011, we will be moving to a new schedule for delivering these provider updates to your in-box. 

We have exciting information to share with you in the coming year. Please share these monthly updates with relevant staff and encourage them to sign up to receive our monthly updates directly by visiting our web site at www.nhp.org.

 Happy Holidays!
On behalf of the entire Provider Relations department and all of us at Neighborhood Health Plan, our very best wishes for the holiday season and the year ahead.

Thank you for the excellent care provided to our members and the continued collaboration extended to our staff. We look forward continue partnering with you in 2011 in delivering the very best care to the population we jointly serve.

Warmest Regards,

Ramona Bourguignon
Director, Provider Relations
Neighborhood Health Plan
ramona_bourguignon@nhp.org

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For all other questions, please contact the Provider Relations department at prweb@nhp.org.