Neighborhood Health Plan
Neighborhood Health Plan Provider News

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In This Issue
New Asthma Trigger Report
In The News!
Imaging Studies Prior Authorization Requests
Leading the Way in Smoking Cessation
Around the Neighborhood Newsletter
New Provider Payment Guideline 
NHP's Urine Drug Testing Provider Payment Guideline is now available.

 

Click here to access other posted Payment Guidelines.  

To inquire about a Payment Guideline not currently listed, just e-mail us at prweb@nhp.org.

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February, 2011
Provider Banner
Greetings!

Greetings!

I hope this message finds you well and keeping up with all the  snow that has come our way recently.

Please find below a brief list of important Neighborhood Health Plan (NHP) updates.
NHP Report Spotlight - Asthma Trigger  Report!

One of the challenges of improving asthma care is the proactive identification of patients struggling with asthma control.  The   new NHP Asthma Trigger Report can help!

 

Previously faxed to network providers, this biweekly report will soon be available exclusively online via our provider portal, NHPNet.  The Asthma Trigger Report identifies NHP patients with current problematic asthma control based on:

  •  A recent asthma ER visit or
  • High recent use of quick relief medication and/or systemic steroids. 

Members included on the report for medication use, must have:

  1.  Filled a prescription for a quick relief medication (beta-agonist trigger) or a systemic steroid (systemic steroid trigger), AND
  2. Filled at least 3 prescriptions for a quick relief medication (beta-agonist trigger) or a systemic steroid in the past 4 months.

The report lists relevant asthma-related utilization (by service date over the past 4 months) of the following services:

 

-          Quick relief medications (dispensed)

-          Systemic steroids (dispensed)

-          Controller medications (dispensed)

-          Asthma emergency room visits

-          Asthma hospitalizations

-          Asthma specialist visit

 

Provision of this important information in the new electronic format allows data manipulation by provider practices to best fit their needs. Confirmation of the report's availability will be provided within the next few day via  NHPNet as users log in. As always, we welcome your feedback on these and all other utilization reports. Providers with questions specific to this new Asthma Trigger Report can contact NHP's Asthma Case Managers Cindy Cookson (617-478-7181 or cindy_cookson@nhp.org) or John Pruett (617-772-5641 or john_pruett@nhp.org).

 

In The News!

We are thrilled to announce that the Association for Community Affiliated Plans (ACAP) has named one of our own, William (Bill) Sweet as a recipient of its annual Making a Difference Award in recognition of his outstanding service to underserved children with disabilities and their families in the community. 

 

Bill is a pediatric nurse practitioner and complex care management coordinator within our Special Kids Special Care program. 

 

The award recognizes ACAP-member plan employees whose performance reflects ACAP's mission by improving their community, supporting underserved populations, and fulfilling community needs. 

 

Bill's work is a shining example of NHP's mission as well and we are extremely proud of him in earning this distinct honor!

 

Click here to read the entire press release or visit the Association for Community Affiliated Plans web site for additional information. 

Imaging Studies Prior-Authorization Requests

Starting this month NHP's Radiology Management partner MedSolutions Inc. (MSI), will request the corresponding CPT and ICD9 codes from callers at the time of a prior-authorization request for imaging studies. In addition, MSI staff will request confirmation  of the caller's approval to process the authorization using the agreed upon codes before initiating the prior authorization request. 

 

When the caller does not have the ICD9 or CPT code available, MSI staff will assist in identifying the codes best matching the request. To expedite the authorization request process, providers are strongly encouraged to validate the associated CPT and ICD9 codes prior to contacting MedSolutions, using the code lookup feature (available from the MedSolutions provider portal upon login) to MedSolutionsonline.com

 

A mutual understanding of these procedure codes at the time the authorization request is made is extremely important to ensure the accuracy of authorized services and mitigate reimbursement discrepancies during claim adjudication. As always, should a need for a correction be identified subsequent to processing of the request, providers can simply contact MSI staff to request to have the authorization updated, proactively ensuring a match to submitted claims. 

 

We appreciate your anticipated cooperation and sharing of this information with relevant staff as you deem appropriate.

Leading the Way in Helping Our Members Quit Smoking!

The American Lung Association's annual State of Tobacco Control report tracks progress on key tobacco control policies at state and federal levels-and grades tobacco control laws and regulations in effect as of January 1, 2011.

 

The federal government, all 50 state governments, and the District of Columbia are graded to determine if tobacco control laws are adequately protecting citizens from the enormous impact of tobacco use.

 

Unfortunately, for the categories of "Tobacco Prevention & Control Spending and Cessation," this year Massachusetts received a grade of "F."

 

Although our state did not score favorably in these categories,  we are pleased to announce that  NHP's Smoking Cessation program continues to excel in all CDC mandates.  According to the report, only one Massachusetts plan (NHP) covers all FDA-approved cessation medications without restrictions.

 

Learn more about NHP's Smoking Cessation  Program!

 

For additional information on the American Lung Association's annual report please visit their web site.  

 

Around The Neighborhood Newsletter

The Winter 2011 edition of Around the Neighborhood, our administrative provider newsletter is now available.

 

Click here to view this latest publication. Archived copies of NHP's clinical and administrative newsletters are also available at www.nhp.org.

Thank You!
On behalf of 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.

 

Provider Relations Department

Neighborhood Health Plan

prweb@nhp.org 

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