Neighborhood Health Plan
Neighborhood Health Plan Provider News

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Visit us often at nhp.org for other important NHP member and provider updates.  


In This Issue
PCP Change Requests
Spinal Surgery Management
Explanation of Payment Copies
Improving Lead Screening Rates
ICD-10 Readiness Update
Important Reminders! 
Our Prior Authorization/Pre-Certification Request form has changed!
 
Click here to view the revised version.
 
Old forms will not be accepted beyond May 31, 2011.
  

 

Enteral Products Authorization Requests Form

A new version of the MCO COmbined Form for Enteral Products Authorization requests is now available!

Click here to view/download a copy and please begin using the new form immediately.  

 

Our

Neighborhood
Member Newsletter

The Spring/Summer edition of our member newsletter is now available.
Click here to access covered topics including: supporting a loved one living with Diabetes, quit smoking help, Ovarian cancer facts, warm weather safety tips and much more!  


Save the Date!

Our next Provider Operations Meeting is scheduled for May 18th.

 

Remote participation is now available. 

 

We look forward to seeing you!

Stay Informed!

 

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community and view archived versions of these monthly provider updates!
 

May, 2011
Provider Banner
Greetings!

Dear Collegue.
 
Please note that we are re-sending this month's NHP Provider News due to an error specific to the 5010 Readiness article. The intended message has been included within.
 
Our sincere apologies for any inconvenience as a result.

PCP Change Requests 

Effective May 16, 2011 changes to a member's Primary Care Provider (PCP) information can be processed only via NHPNet.

This applies to PCP changes within the same site/group NPI. In support of this change and response to provider feedback, for those primary care offices with satellite locations, we are further enhancing the current PCP change functionality to allow changes accross practice locations sharing the same group NPI.

Changes to a member's primary care site will be processed only after verifying with the member. As such, it is recommended that these be initiated by the member directly. However, providers can also fax a completed Primary Care Site Change Form, signed by the member to our Customer Care Center for processing. The current form is being revised to accommodate this upcoming change. Availability of the revised form will be confirmed via the Provider News section our web site at www.nhp.org.

As always, other member demographic updates can be reported to our Customer Care Center by the member or the provider.

We appreciate our network's assistance in maintaining accurate member information.  

 

Spinal Surgery Prior Authorization Changes Reminder

Last month we shared news of our partnering with Focus Health to provide NHP with consultative reviews of prior authorization requests for spinal surgery effective May 1, 2011.

 

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.

 

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 can be initiated by either NHP or a Focus Health representative acting on behalf of NHP.  

 

When separate group NPIs apply, professional and facility approval requests will be processed accordingly; however, we have revised our Prior Authorization Request Form such that the information for the billing facilty and the billing physician can be provided via a single request. Please remember to use only the new form going forward.

 

Please see our April NHP Provider News for additional information regarding this change. The corresponding payment guidelines will be available on our web site on or before May 16, 2011. Please contact our Customer Care Center at 800-462-5449 or your NHP Provider Relations representative directly should you have questions in the meantime. 

Explanation Of Payment (EOP) Requests

 

Effective June 1, 2011 copies of Neighborhood Health Plan EOPs will be available exclusively via our provider portal NHPNet.

 

We have significantly enhanced the response time and the average wait time for an EOP copy is less than 90 seconds, depending on the EOP size.

 

Access to the most recent EOP is available Thursday mornings immediately following NHP's weekly check run. Historical EOPs (retroactive to 2008) are also available for viewing/downloading.

Improving Lead Screening Rates

The 2010 "Health of Massachusetts" report identified the cities of Lynn and Lawrence among the highest risk communities for childhood lead poisoning. 

 

In our ongoing commitment to improving the health of our members and given the high NHP member penetration in these communities, we are partnering with the Department of Public Health (DPH) in joint reminders from DPH Commissioner John Auerbach and NHP's Senior Medical Director Dr. James Glauber to parents or guardians of children living in these two cities who have not yet received a lead screening. 

 

Parents/guardians will begin receiving these reminder notices this month and we are extremely grateful to DPH and Commissioner Auerbach for the opportunity to collaborate in such an important patient care initiative.


For community-specific findings, please review the DPH Screenings and Incidence Statistics by Community report.

ICD-10 Readiness Update

On January 1, 2012 HIPAA version 5010 becomes effective replacing the current 4010A1 version. Covered entities (health plans, professional and institutional healthcare providers as well as clearinghouses) will be required to use the new 5010 standards when conducting eligible electronic transactions.

 

These include:

  • claims submissions (837)
  • claims status (276/277)
  • claims payment/remit (835)
  • eligibility (270/271)
  • referrals, certification & authorizations (278)
  • member enrollment and disenrollment (834)
  • health plan premium payments (820)

Changes to the data currently exchanged by covered entities are anticipated, resulting in potential system adjustments for both payers and providers.

NHP expects to be fully compliant by the deadline. Our conversion strategy includes:

  • Review of internal business processes, system modifications and corresponding testing
  • Deployment and testing of new codes as needed
  • Internal and external 5010 specific communication plan
  • Review of staff and provider training and reference materials

We anticipate limited testing with providers to begin in mid May 2011 followed by full testing in mid June. 

 

Providers are encouraged to email us at [email protected] to share testing schedules and overall conversion strategy, including plans for concurrent 4010 and 5010 testing, if any.

  

Testing specific inquiries may be directed to [email protected]. For all other 5010  questions and/or general inquiries, please contact your NHP Provider Relations Representative directly or email Provider Relations at [email protected].

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

[email protected] 

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