Greetings!
Greetings!
We hope this message finds you well on this first day of April. Clearly Mother Nature fooled us all into thinking winter is now bedind us!
Please find below a brief list of important Neighborhood Health Plan (NHP) updates.
|
| Spinal Surgery Prior Authorization Management |
|
In our continuous efforts to dentify and implement quality initiatives designed to support patient care efforts,improve services to our members, while also controlling medical costs,
we have chosen Focus Health to provide NHP with consultative reviews of prior authorization requests for spinal surgery.
Focus Health is a medical management services organization specializing in the evaluation of pain management services, including spinal surgery, and uses proprietary criteria and nationally recognized clinical guidelines in their evaluation processes.
There is no change to NHP's existing authorization requirements for spinal surgery:
- Prior authorization continues to be required for these services when rendered to any NHP member
- Providers should continue to submit documentation to NHP at the time of the request that they believe supports the medical necessity of the procedure
- Elective spinal surgery requests must be submitted at least five (5) business days prior to the service date
Summary of Changes Effective May 1, 2011
- For spinal surgery services (including those in an emergency setting) additional supporting clinical information may be requested before the request can be finalized by NHP
- This request might be initiated by either NHP or a Focus Health representative acting on behalf of NHP.
- NHP will use clinical expertise from Focus Health to recommend service appropriateness according to evidence- based clinical criteria. In all circumstances, NHP remains responsible for final medical necessity determinations.
- When separate group NPIs apply, professional and facility approval requests will be processed accordingly. However, the information may be provided via a single form and NHP's Prior Authorization Request Form will be modified accordingly.
NHP will provide additional updates regarding this important change in the coming weeks via our website, this monthly newsletter and other communication vehicles.
|
|
Provider Termination Requests |
|
The form for notifying NHP of clinicians no longer employed by a contracted provider entity has been recently updated.
Click here to download a copy of the new form and please be sure to use this template going forward. |
|
DME Coverage Changes Reminder |
In December we notified you of the elimination of calendar year limits for Durable Medical Equipment (DME) effective April 1, 2011.
To minimize premium increases as a result, a 20% coinsurance has been added to the DME benefit. This change applies only to Business Choice HMO and Commonwealth Choice plans within our Commercial line of business.
DME coverage varies by specific plan. Additional plan specific information is available via our website at www.nhp.org. Members with questions may be directed to our Customer Care Center at 800-462-5449 for additional assistance. |
|
Provider Payment Guidelines |
|
The following Payment Guidelines are now available:
Click here to access all available Payment Guidelines. |
| 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 |
| Your NHP Profile Information |
Please Note: the information above is based on data provided to NHP and voluntarily updated by the recipient. To update your contact information click here.
|
