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Check us out!
Visit us often at nhp.org for other important NHP provider updates. |
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NHP Provider Manual
Click here to quickly access our online Provider Manual.
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NHP Provider Payment Guidelines
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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Clinical Resources
Click here to access
relevant
Clinical Practice Guidelines, our Drug Look Up database and other important clinical resources. |
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Revised Provider Forms
The following Provider Forms have been recently updated:
Please begin using theseimmediately and discard any older versions. | | |
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Informational Webinars
Are you familiar with the many clinical reports NHP makes available to Primary Care Sites?
If not, click on the links below to join one of our upcoming educational webinars: | |
Friday, October 14th
OR
Wednesday, October 19th |
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Greetings!
Greetings! We hope this message finds you well as we welcome the Fall season. Please find below a list of important Neighborhood Health Plan updates. |
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Domestic Violence Awareness Month |
October is Domestic Violence Awareness Month.
To that end, we proudly present the new NHP Domestic Violence Program website.
The site, which was designed to be readable and appropriate to individuals of all backgrounds, includes important information about the prevalence and health consequences of domestic violence and provides local and national resources for both members and providers, including tips for helping victims.
It is our hope that this site serves as a valuable tool for patients who wish to learn more about domestic violence and the resources available to them.
Click here to access the site now. To share feedback on how we might improve this new site, please email us at prweb@nhp.org.
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Claims Status Check Made Easier! |
You asked. We listened!
In response to provider feedback, we are pleased to announce significant enhancements to the Claim Status feature of NHPNet.
In a matter of seconds, you can now perform the following functions:
- Search by claim number
- with associated reasons for denied or reversed claims;
- plus a direct link to the corresponding NHP Explanation of Payment (EOP)
- Search by member ID number
- including an option to look up the member ID when not readily available
- View some or all claims for a specific member
- claims submitted within the last 30, 90 or 180 days
- claims submitted within the last year
- claims submitted within the last 2 years;
- OR all claims for a given member
- Get a report of all claims submitted by your provider group
- OR, narrow your search to view:
- finalized claims only
- only claims still in process by NHP (and scheduled to pay, deny or be reversed)
- claims submitted by your office within a specific window
- claims for a specific date of service range
- claims finalized by NHP within a specific check run (EOP)
In addition, our Claims Status screen now includes the allowed equivalent plus specific co-pay and deductible information, when applicable.
To view your reports now, click here to log in to your NHPNet account.
As always, we thank you for your feedback. Be sure to read these monthly updates as we'll be communicating additional enhancements in the coming weeks specific to streamlining authorization request submissions. |
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Potentially Preventable Re-admissions Important Update! |
In our last issue we communicated changes to NHP's reimbursement for Potentially Preventable Re-admissions (PPR).
After carefully reviewing feedback received from our provider constituency, we want to notify you of our decision to temporarily suspend implementation of the PPR coverage policy while we collaborate with the Massachusetts Hospital Association, MassHealth and others in developing a methodology that achieves the objectives of all parties.
Please disregard our previous correspondence and kindly notify relevant staff as you deem appropriate.
Should you have any questions in the meantime, please contact your NHP Provider Relations Representative directly. |
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Behavioral Health Screening Requirements | |
As of December 2007, the State mandates that all MassHealth members from 0 through 20 years of age receive behavioral health screenings as part of Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) services.
Although the requirement applies to MassHealth members only, in our continuous quality improvement and administrative simplification efforts, NHP reimburses the screening for all members, regardless of product.
As part of our data collection process, we have identified differences among age cohorts and deficiencies in certain areas, thus we are asking for your support in helping us identify potential barriers.
Your honest feedback to 4 questions will be critical in helping us improve behavioral screenings for NHP's pediatric population. Click here to respond to the survey and thank you for your ongoing support! |
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Pharmacy Co-pay Changes
MassHealth & Commowealth Care Members | |
A reminder that as of October 1, 2011, the pharmacy co-pays for certain generic, over-the-counter (OTC) and brand name drugs have changed for all NHP MassHealth and certain Commonwealth Care members. These changes are as follows:
- co-pays have changed from $3.00 to $3.65. This applies to generic and brand-name drugs (both first-time prescriptions and refills) as well as over-the counter (OTC) drugs covered by NHP.
- co-pays 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
Please note that this copay increase applies to all NHP MassHealth members but to NHP Commowealth Care Plan Type 1 members only.
Additionally, the annual cap on the amount of co-pays members (age 19 and older) must pay remains at $200 for calendar year 2011. However, it will change to $250 in January of 2012 for MassHealth members and July of 2012 for Commonwealth Care Plan Type 1 members.
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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Helping Our Members Manage
High Blood Pressure | |
Do you know that with a prescription from their provider, NHP members are covered for the cost of high quality ambulatory blood pressure monitors such as the Omron 711DLX?
In addition, to increase compliance with medication management and help our members keep their blood pressure under control, we offer our members the option of avoiding the need to refill their prescription monthly. This is possible via our Access 90 program.
With this Program, NHP members can get a convenient 3-month supply of their regular medications at participating NHP pharmacies such as Walgreens, Rite Aid and Stop & Shop.
Visit our web site for additional information about our Access 90 and Mail Order Programs, as well as our covered Over the Counter drugs and other information regarding NHP's Pharmacy benefit. |
| 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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