At NHP, our highest priority is assuring that our members receive the appropriate care, at the appropriate time, and with the appropriate provider. Consistent with our mission to ensure affordable, equitable care for our members, effective for services rendered on or after January 1, 2012, NHP will be instituting a specialty referral requirement for NHP Commonwealth Care and NHP MassHealth members.              

Specialty referrals will be required for all services/specialists except the following:

• A Gynecologist or Obstetrician for routine, preventive, or urgent care
• Family planning services provided by any MassHealth or Commonwealth Care provider
• Outpatient and diversionary Behavioral Health Services
• Emergency services

Additional information on this new requirements should have arrived in your office via U.S. mail. We will be working with PCPs and our members to ensure appropriate continuity and transition of care plans are in place to minimize disruptions.

To streamline the processing of referral and prior authorization requests, NHP will be adding functionality to our provider portal (NHPNet) to enable online submission and follow-up on referrals and prior authorizations. Beginning 1/1/12, all referrals and most authorizations will be accepted only through NHPNet.

Additional information will be provided over the next few weeks via this monthly newsletter, NHPNet and the NHP web site. In the meantime, please contact your Provider Relations representative or the NHP Customer Care Center with any questions.  

In response to provider feedback, and as part of our continuing efforts to improve administrative efficiencies and support, we are excited to share with you important changes to our current customer service structure:

New Provider Service Center

On December 1, 2011 NHP will launch a new Provider Service call center comprised of highly-skilled NHP service representatives with expertise in provider-specific matters.  Additionally, select Provider Service Center representatives will be equipped to perform some adjustments over the phone, minimizing internal dependencies.

New Dedicated Provider Service Phone Number

To support the new Provider Service Center, a new toll-free number for Providers is being established. Beginning December 1st, the number to call into NHP's new Provider Service Center is (855) 444-4NHP (4647). This number will provide direct contact to the appropriate NHP provider service personnel. 

Phone Tree Re-design

Our phone tree has been modified to streamline prompts and create greater call-routing efficiencies to help ensure our service goal of first-call resolution. NHP's Provider Advisory Board was consulted on the new work flow, allowing us to incorporate feedback from multiple provider constituencies.

New Hours

The provider customer service hours will also change to 8:30 am to 5:00 pm Monday through Fridays. Please make a note of this important change when requiring assistance from NHP staff after hours for those services not available via our provider portal, NHPNet. A reminder that on Thursdays our call center currently closes briefly between 3:00 and 4:00 pm for training purposes.

We know your time is valuable and we hope that these changes yield a positive impact in doing business with NHP in the future.

As a reminder, our provider portal (NHPNet) is available 24 hours a day, 7 days a week to provide access to many transactions within seconds and without a dependency on Provider Service staff. Thousands of NHP network providers are already taking advantage of this provider self-service option to check eligibility, claims and authorization status, preview /download copies of NHP Explanation of Payment, and process PCP assignment corrections, to name just a few!

Watch your mail for a notification from NHP providing additional details and please share this information with other staff in the meantime as you deem appropriate.

Effective for services rendered on or after January 1, 2012 Neighborhood Health Plan's reimbursement for the specific modifiers below will change as follows:

• Modifier 25 - Significant, separately identifiable E&M service by same physician on same day of procedure or service:50% of NHP's allowable fee schedule
• Modifier 53 - Discontinued Procedure:25% of NHP's allowable fee schedule
• Modifier 59  - Distinct procedural service: 50% of NHP's allowable fee schedule
• Modifier 74 - Discontinued outpatient / ASC procedure after anesthesia administration: 50% of NHP's allowable fee schedule
• Modifier 78 - Unplanned return to OR for related procedure during post-op period: 75 % of NHP's allowable fee schedule.

Our Modifier Payment Guidelines will be modified accordingly. In the meantime, please share this information with relevant staff as you deem appropriate.