Greetings!
Greetings! Please find below a list of important Neighborhood Health Plan updates. |
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Online Authorizations and Referrals Update |
We have made significant progress on identifying the technical issue encountered yesterday with the Authorization and Referral module. Unfortunately, we have been unable to resolve the issue in its entirety. As a result, we are postponing the launch of the Authorization & Referral module on NHPNet at this time.A new go-live date will be communicated to you by Wednesday, February 8.
Please note that NHP will not require referrals for specialty services until the Authorization and Referral module issue has been addressed and the new go-live date has been established and communicated. Again, we apologize for the inconvenience and we understand that this delay has caused disruption for you and your staff.
Please continue to fax authorizations to NHP's existing fax lines until the issue is resolved and a new go-live date has been communicated.
Thank you for your patience. Please contact your NHP Provider Relations Representative if you have any questions. |
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National Drug Code Requirement |
Regulations require NHP, as a contracted MCO with the Commonwealth of Massachusetts, to collect and report NDC codes for drug claims. This requirement is a result of the Deficit Reduction Act of 2005 (DRA) which requires states to collect
rebates for physician-administered drugs. The DRA expanded the rebate requirement to physician-administered drugs.
Effective April 1, 2012, Neighborhood Health Plan will require the 11-digit National Drug Code (NDC) on all outpatient claims for drugs administered during a patient's visit in addition to the HCPCS code in order to be compliant with the State regulations. Providers will need to submit claims with both HCPCS and NDC codes to NHP with the exact NDC that appears on the medication packaging in the 5-4-2 digit format (i.e. xxxxx-xxxx-xx). This coding requirement will apply to all NHP members regardless of product line.
NHP will reject all outpatient claims with physician-administered drugs submitted as of April 1st without the appropriate NDC code, and claims will be subject to re-filing and filing limits.
Below you will find a link to frequently asked questions that will assist in clarifying this coding requirement change.
National Drug Code Frequently Asked Questions |
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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. |
| NHP's Formulary Drug Lookup |
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Our Drug Lookup is a searchable da¬tabase designed to provide information about NHP drug coverage. It provides the following information:
To acess the the drug lookup tool, please click here. |
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Modifier Changes Update |
Our November eNewsletter indicated an incorrect reimbursement rate when modifier 59 is used. Please read our Modifier Payment Guideline to view the correct reimbursement rate. |
| Thank You! |
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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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