Neighborhood Health Plan
Neighborhood Health Plan Provider News
In This Issue
New & Revised Payment Guidelines
NHP's Formulary Drug Lookup
Hospital Quarterly Admissions Report
Sleep Management Solutions (SMS) Update

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Clinical Practic
e Guidelines, our Drug Look Up database and other important clinical resources. 

May, 2012
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Please find below a list of important Neighborhood Health Plan updates.

New & Revised Payment Guidelines 

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. 

NHP's Formulary Drug Lookup

Our Drug Lookup is a searchable database designed to provide information about NHP drug coverage. It provides the following information:   

  • Whether a drug is covered under a member's plan
  • Copay information (drug tier)
  • Prior authorization requirements and other plan limitations
  • Availability of a drug through NHP's Access90 program
  • Availability of a drug through NHP's mail order program

Please utilize the tool at the following link:


Formulary Drug Lookup  

Hospital Quarterly Admissions Report  

The current Quarterly Hospitals Admission Report is now available on NHPNet. Please login today to retrieve this information. 

Sleep Management Solutions (SMS) Update  

NHP has partnered with Sleep Management Solutions (SMS) to provide sleep diagnostic and therapy management services for all NHP product lines. Click on the link below to go to the SMS website.

Sleep Management Solutions
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 

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