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Check us out!
Visit us often at nhp.org for other important NHP provider updates. |
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Click here to quickly access our online Provider Manual.
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To view all NHP Provider Payment Guidelines just click here! |
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Save the date!
Our next Provider Operations Meeting
will be on Wednesday, November 16th.
Watch your in-box for an invitation and additional details.
We look forward to seeing you! | | |
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Stay Informed!
Not getting NHP updates directly?
Click here to join our e-news Provider
community and also view archived versions of these monthly provider updates!
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Do you have an NHPNet account?
Click here to register otherwise and join thousands of other providers currently taking advantage of this great self-service option! | | |
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Click here to access
relevant
Clinical Practice Guidelines, our Drug Look Up database and other important clinical resources. |
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Greetings!
Greetings! This provider newsletter replaces the newsletter sent on September 1, 2011, incorrectly labeled August 2011. We've corrected the date and made additional corrections to the Consultation Code Reimbursement Change Notification. We apologize for any disruption the previous notification may have caused.
Please share this information with staff as you deem appropriate and contact your Provider Relations Representative with any questions.
Please find below a list of important Neighborhood Health Plan updates. |
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PCP Clinical Reports Now Available!
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The most recent versions of the NHP quarterly and other PCP reports are now available for your review including the newest addition to our menu; a report of 7 months infants with less than 3 well-child visits.
Other available reports include ER utilization data, mammography screening and immunization rates plus Asthma and Diabetes specific patient data.
The average reports takes less than ten seconds to generate! To view your reports now, click here to log in to your NHPNet account.
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Potentially Preventable Readmissions |
Effective October 1, 2011 Neighborhood Health Plan (NHP) does not reimburse acute care hospitals for Potentially Preventable Re-admissions (PPRs) related services within 30 days of the admission.
A Potentially Preventable Re-admission (PPR) is defined as a readmission that is clinically-related to the prior initial admission or clinically-related to the initial admission within a readmission chain.
NHP utilizes the 3M™ Health Information Systems Potentially Preventable Readmission Classification System to identify incidents of admissions/re-admissions whether or not these occur at the same or different acute care hospitals.
For additional information, please reference the NHP Potentially Preventable Readmissions Payment Guidelines. |
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Provider Payment Guideline Updates
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The following Provider Payment Guidelines have been recently developed or revised and are now available:
For revised payment guidelines, please refer to the last page of each guideline for additional details on the scope of changes.
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| Pharmacy Co-pay Changes - MassHealth Members | |
Effective October 1, 2011, the pharmacy co-pays for certain generic, over-the-counter (OTC)and brand name drugs are changing for all MassHealth members, including those enrolled in Neighborhood Health Plan, as follows:
- co-pays will go up from $3.00 to $3.65. This applies to both first-time prescriptions and refills for generic drugs, over-the counter (OTC) drugs and brand-name drugs covered by NHP.
- co-pays will continue to be $1.00 for both first-time prescriptions and refills for each generic drug and OTC drug covered by NHP in the following drug classes:
- antihyperglycemics
- antihypertensives
- antihyperlipidemics
The cap on the amount of co-pays members (age 19 and older) must pay will remain at $200 for calendar year 2011 and will go up to $250 in calendar year 2012.
As always, for NHP MassHealth members unable to pay a co-payment at the time of service, the pharmacy must fill the prescription. However, the pharmacy can bill the member later for the co-payment.
In addition, please note that the following MassHealth members are exempt from prescription co-pays:
- under 19 years old;
- pregnant or pregnancy ended within 60 days of the service;
- an inpatient in an acute hospital, nursing facility, chronic-disease or rehabilitation hospital, or intermediate-care facility for the developmentally delayed, or are admitted to a hospital from such a facility;
- getting hospice care;
- enrolled in MassHealth because they were in the care and custody of the Department of Children and Families (DCF) when they turned 18, and their MassHealth coverage was continued;
- Native American or Alaska Native from federally recognized tribe;
- members who reached the pharmacy co-pay cap for the calendar year.
Please share this information with staff as you deem appropriate and contact our Customer Care Center at 1-800-462-5449 with any questions.
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Consultation Codes Reimbursement Change |
Effective November 1, 2011, Neighborhood Health Plan will no longer reimburse for the following codes:
Office Consultation: Codes 99241, 99242, 99243, 99244, 99245.
Please resubmit with the appropriate complexity level office visit E/M CPT code: 99201-99205 (Office or Other Outpatient Visit-New Patient) or 99211-99215 (Office or Other Outpatient Visit, Established Patient).
Inpatient Consultation: Codes 99251, 99252, 99253, 99254, 99255.
Please resubmit with the appropriate complexity level hospital inpatient service E/M CPT code: 99221-99223 (New or Established Inpatient Hospital Care), 99231-99233 (Subsequent Hospital Care).
In the inpatient setting, the principal physician of record must append the alpha modifier "AI" to the inpatient E/M code when reported. This modifier will identify the physician who oversees the patient's care from all other physicians who may be furnishing specialty care. All other physicians who perform an initial evaluation on this patient shall bill only the E/M code for the complexity level performed.
Inpatient consultations billed with 99221-99223, 99231-99233, when the consulting physician is not face-to-face with the patient in the facility, e.g. conducted via telephone, or video-conferencing.
Claims reflecting these no longer recognized CPT "Consultation" codes on or after November 1, 2011 will deny as non-covered services. The corresponding provider payment guideline has been revised accordingly. |
| 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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| 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.
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