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Check us out!
Visit us often at nhp.org for other important NHP provider updates. |
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Our provider manual has been updated as of 2/1/12. Click here to quickly access our online Provider Manual.
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Stay Informed!
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community and also view archived versions of these monthly provider updates!
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To view all NHP Provider Payment Guidelines just click here! |
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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
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Clinical Practice Guidelines, our Drug Look Up database and other important clinical resources. |
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Greetings!
Greetings! Please find below a list of important Neighborhood Health Plan updates. |
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Online Authorizations and Referrals Update
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Effective March 19, 2012, Prior Authorizations for all members and Referrals for MassHealth & Commonwealth Care members must be submitted through NHPNet. Only requests for benefit exceptions, out of network providers and some services can be initiated by fax.
We will soon be posting updated versions of our Quick Start Guides to show you how simple it will be to enter authorizations and referrals via the portal. The guides will be posted to Provider section of NHP.org once available.
We have also updated our guide showing which services will require electronic submission for authorization or notification. Please review the guide here.
Please contact your NHP Provider Relations Representative if you have any questions.
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Sleep Studies Update
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Effective for dates of service beginning May 1, 2012, NHP is partnering with Sleep Management Solutions (SMS) to provide sleep diagnostic and therapy management services for all NHP product lines. Neighborhood Health Plan will require you to request authorization from SMS prior to a Neighborhood Health Plan member receiving a sleep study (Polysomnography/Titration Study/Home Sleep Test/MSLT) and/or sleep therapy (CPAP, Bi-level, Bi-level ST, and all PAP supplies), services. Failure to notify SMS in advance of delivering a sleep service will result in claims payment denials. Beginning March 19, 2012, you will be able to find a reference guide on www.sleepmanagementsolutions.com that provides useful information to assist you with the prior authorization process.
Services that Require Prior-Authorization
- Sleep Diagnostics (94660, 94799, 95805, 95806, 95807, 95808, 95810, 95811, G0398, G0399, G0400)
- Therapy ( E0470, E0471, E0561, E0562, E0601)
- Supplies (A4604, A7027, A7030, A7031, A7032, A7033, A7034, A7035, A7036, A7037, A7038, A7039, A7044, A7045, A7046)
For more information, read the Provider Notice.
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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. |
| PCP Panel Status | |
Have you logged onto NHPNet recently to verify the accuracy of your provider roster and PCP panel status? NHP strongly recommends frequent review of NHPNet's Provider Roster Report to ensure we have all of your providers linked to your group and that we are listing their panel status correctly.
To view the report, logon to NHPNet and click on the Other Reports tab. From there, select Provider Roster Report from the drop-down menu and then click Run Report.
If you notice any discrepancies within the report, please notify your Provider Relations Representative or send an email tlo prweb@nhp.org.
If you have access to NHPNet and you are not able to view the Provider Roster Report, please contact your Site Administrator and ask them to grant you access.
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Behavioral Health Screenings
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Neighborhood Health Plan (NHP) requires that Primary Care Providers (PCPs) offer periodic and medically necessary inter-periodic screens to members under the age of 21 in accordance with the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) and Preventive Pediatric Healthcare Screening and Diagnosis (PPHSD) Periodicity Schedules. This requirement applies to MassHealth members only. However, to minimize administrative complexities and in our continuous quality improvement efforts, NHP covers this service for all members.
NHP reimburses one (1) screening per member per day, regardless of the number of screening tools administered for a member on a single day.
To be eligible for reimbursement, Primary Care Providers (MDs and NPs) must use specific, clinically appropriate behavioral health screening tools accommodating different age ranges while allowing some flexibility for provider preference and clinical judgment. Additionally, procedure code 96110 must be billed with the appropriate U modifiers (U1 - U8) indicating the type of provider who conducted the screening and whether a behavioral health need was identified.
Claims submitted without the corresponding U modifier are subject to deny.
Please share this important change with billing and other staff as you deem appropriate. Additional information on this requirement is available within the Billing section of our Provider Manual.
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| 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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