Neighborhood Health Plan is adopting these guidelines to; align with local and national industry standards, and support our company mission of offering a trusted solution for affordable high quality care for diverse communities.
New Preventive Colonoscopy Provider Payment Guideline
Effective 4/1/12, no cost sharing will be taken for any preventive screening colonoscopies. The specified diagnosis codes must match exactly the procedure codes listed in the applicable code table in guideline. Minimum age limits have been significantly lowered, and there will be no frequency limit placed on the benefit. Where applicable, Cost Share will continue to apply to additional procedures and their associated services which may be billed on the same claim.
Revised Diagnostic Imaging Provider Payment Guideline Changes
Effective July 1st, 2012 when two or more reimbursable imaging services are performed on the same date of service, at the same encounter, in all places of service, a 50% reduction of the lower priced radiologic services will be taken on the technical only (performance of the imaging), and technical performance of the global (performance and interpretation) services when certain imaging procedure code combinations are billed for a single member at the same encounter. Codes identified in the policy when submitted at the same encounter are subject to the reimbursement reduction.
New Standard Blood Products and Services Payment Guideline
There is a new guideline to facilitate correct submission of codes for medically necessary administration (transfusion) of blood and standard blood products. Standard blood products are defined as components (a product removed from whole blood by physical procedures) and derivatives (a product removed from whole blood by chemical procedures).
Please click here to obtain current copies of all our payment guidelines.