Neighborhood Health Plan
Neighborhood Health Plan Provider News
In This Issue
Women's Preventive Health
Pharmacy Updates
New Plan Year Products
Clinical Criteria Guidelines
Online Authorization & Referrals
My NHP Profile

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July, 2012
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We hope this message finds you well and enjoying the warm weather we've been fortunate to experience over the past few weeks.  

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

Women's Preventive Health   

NHP is pleased to inform you that effective August 1, 2012, in accordance with the Patient Protection and Affordable Care Act (PPACA): Copayments, deductibles, or coinsurance will no longer be applied to certain women's preventative health services. NHP has already been voluntarily offering many of these services to its members with no cost-sharing; the PPACA mandate is now making it a requirement.

Services include:
  • Well-woman visits, including an annual well-women preventive care visit for adult women and any needed follow-up visits for preventive care
  • Gestational diabetes screening for women 24 to 28 weeks pregnant
  • (HPV) DNA testing every three years for women age 30 or older
  • Counseling for sexually transmitted infections (STIs) and HIV screening
  • All FDA approved contraceptive methods, sterilization procedures, and patient education and counseling
  • Breastfeeding support, supplies, and counseling
  • Domestic violence screening

We will be updating NHP Payment Guidelines to reflect this information and will notify you through a follow-up E-Newsletter. Please continue to verify member benefits, drug coverage, and authorization requirements prior to rendering care-as member benefits and coverage may vary by plan type.


For more information about Affordable Care Act Rules on Expanding Access to Preventative Services, please visit 

Pharmacy Updates  

New Mail Order Pharmacy: informedMail™

Effective July 16, 2012, informedMail™ Prescription by Mail Service will become the mail order pharmacy for NHP members. InformedMail offers a convenient and cost-effective way for members to receive maintenance medications.

  • All eligible members will need to enroll with informedMail in order to receive prescriptions through the mail. 
  • Members not already enrolled with our current mail-order vendor will need to enroll with informedMail in order to receive prescriptions through the mail. 
  • Members who already use mail-order services and have refills remaining on their prescriptions will have their prescriptions transferred automatically to informedMail. 
  • Members who already use mail-order services but have no remaining refills will need a new prescription. 
  • MassHealth members are not eligible for this mail-order benefit.

InformedMail pharmacists are available to answer members' questions or concerns about their medication, 24 hours a day, seven days a week.

Maintenance 90 Program  
Also effective July 16, 2012, NHP members will be enrolled automatically in a new Maintenance 90-day supply program for ongoing prescription refills.

Members who have filled a maintenance prescription at least twice in the past four months will need to fill a 90-day supply on their next fill. As a result, members or their pharmacy will contact you for a new prescription. Please provide your patients with a 90-day script as soon as possible.

All maintenance medications (such as those for high blood pressure or diabetes) will require a 90-day prescription. For the most up-to-date list of maintenance medications, use the Drug Lookup Tool at

Please stay tuned to our Pharmacy website for additional details. 

New Plan Year Products 

On July 1, 2012, NHP launched six new plan year  products!  Unlike a calendar year benefit period, plan year products utilize the group's specific anniversary date to start and reset members' benefit accumulators.  Please review the Benefit Summary for plan and benefit information.

NHP Plan Year Member Handbook

NHP Plan Year 250
NHP Plan Year 500
NHP Plan Year 1000
NHP Plan Year 1500
NHP Plan Year 2000
NHP Plan Year 2000/4000 

Clinical Criteria Guidelines  

NHP utilizes McKesson's InterQual® and develops medical necessity guidelines and criteria to review medical appropriateness of targeted services, based on its member population and service utilization. Guidelines and criteria are objective and based on medical evidence, using various professional and government agencies and local health care delivery plans. Utilization management (UM) criteria and procedures for their application are reviewed at least annually, and criteria are updated when appropriate.  NHP elicits opinions, advice and comments from area practitioners when developing UM criteria. NHP applies the criteria based on individual circumstances and needs and takes into account the local delivery system when determining the medical appropriateness of health care services.

Beginning July 15th you can view and print NHP's Clinical Criteria Guidelines by going to, selecting Providers, and then Clinical Resources

Online Authorization & Referrals  

As we've previously communicated, effective September 10, 2012, Prior Authorizations and Referrals for all members must be submitted through NHPNet. Only requests for benefit exceptions, out of network providers and some services can be initiated by fax.

Please use this time to ensure you and your staff have appropriate access to NHPNet. Please stay tuned to for additional updates prior to the launch date.
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



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