Neighborhood Health Plan
Neighborhood Health Plan Provider News
In This Issue
June 4th, 2012 InterQual® Implementation
HCAS Provider Technology Adoption Survey
GIC Annual Leapfrog Hospital Survey
Commonwealth Care Open Enrollment

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June, 2012
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We hope this message finds you well and enjoying the start of summer! 

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

InterQual® Implementation (June 4th, 2012) 

NHP is pleased to follow up on a previous communication sent in March, 2012 that described our intention to adopt the InterQual®  Level of Care Criteria for:  Acute Care, Rehabilitation, Sub-Acute and Skilled Nursing Facility. These criteria sets will be applied to inpatient admissions for adult and pediatric patients.

Effective June 4th 2012, supporting clinical information for admissions will be required for all concurrent review and the clinical information provided must meet InterQual® criteria standards to support approval for payment.  Clinical information to substantiate the medical necessity for authorization must be received prior to the end of the previously authorized days, or payment may be denied.  

NHP Care Managers will continue to be available to you and your staff, offering assistance and support for discharge planning and will work collaboratively with you to meet the needs of members; particularly those with complex medical needs.  We appreciate your excellent care of Neighborhood Health Plan members and your cooperation as we implement the change.  Should you have any questions, please contact your Provider Relations Representative directly or NHP's Provider Service Center at 1-855-444-4NHP (4647). 

HealthCare Administrative Solutions Provider Technology Adoption Survey

What Health Care Technologies Do You Use?

To assist its member health plans to collect statewide provider technology use information and to meet All-Payer Claims Database requirements established by the Massachusetts Division of Health Care Finance and Policy, HealthCare Administrative Solutions (HCAS) will release one unified
health plan survey to streamline the data collection process. Organizations participating in this survey include: Blue Cross Blue Shield of Massachusetts, Boston Medical Center HealthNet Plan, Fallon Community Health Plan, Harvard Pilgrim Health Care, Health New England, Neighborhood Health Plan, Network Health and Tufts Health Plan.

The survey takes only a short time to complete and will be available beginning June 1, 2012. A group submission process is also available for facilities and large groups to submit survey responses for their providers.

Providers are asked to complete the survey by July 15th to ensure that survey data is received in a timely manner. The information collected through this survey process will be submitted to the health plans participating in this project and to the Massachusetts Division of Health Care Finance and Policy.

For more information and to access the Provider Technology Adoption Survey, please visit

What NHPNet does for you today! 

From batch claims searches to PCP changes to batch authorization reports, NHPNet is your first point of contact when conducting business with NHP.  NHPNet currently handles over 400,000 total transactions per month, as evidenced by the following monthly figures: 
  • 39,000+ authorization status verifications 
  • 35,000+ claim status status verifications  
  • 114,000+ eligibility verifications

Reminder, effective September 10, 2012, all referrals and most authorizations for all lines of business will be required to be entered via NHPNet


The NHPNet User Guide has been updated and is now a full walk-through showing how to use all features of NHPNet.  Please login to NHPNet to obtain the new copy.

Don't have an NHPNet account? Please click here to register.


GIC Annual Leapfrog Hospital Survey

The Group Insurance Commission (GIC) 2012 Leapfrog Survey has just been released to all Massachusetts acute care hospitals.


Hospitals have until June 30, 2012 to respond to the survey in order to be eligible for consideration for Leapfrog's Top Hospital Awards.  Please respond to the survey by June 30, 2012.   


Please click here to access the survey. 

Commonwealth Care Open Enrollment 2012
Comonwealth Care Open Enrollment begins today! Only during this time of year can members change their health plan for any reason. This year, the time to make a health plan change is from June 1st - June 22nd.  A health plan change made during this time will take effect July 1, 2012.

Please click here for more information. 
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 

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.