Neighborhood Health Plan
Neighborhood Health Plan Provider News
In This Issue
Sept. 10, 2012 - Online Authorization & Referrals
Maintenance 90 Program Updates
Provider Payment Guideline Updates
Clinical Coverage Criteria Updates
CAQH Supporting Documentation
CDC Growth Charts
My NHP Profile

Looking for a copy of a previous E-Newsletter? All prior editions are located at this link.

2012 Quarter 2 Clinical Reports are now available on NHPNet!  Login today to see reports relevant to your site.

Clinical Coverage Criteria are now available!  Please click here to access.

Click here to quickly access our online Provider Manual.



To view all NHP Provider Payment Guidelines just click here!

Stay Informed!


Not getting NHP updates directly?


Click here to join our e-news Provider 

community and also view archived versions of these monthly provider updates!

September 2012
Provider Banner


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

Effective Sept. 10, 2012 - Online Authorizations & Referrals

As previously communicated, for services rendered on or after September 10, 2012, Neighborhood Health Plan (NHP) will be instituting online specialist referral requirement with the exception of the following services. Referrals will need to be submitted directly through NHP's on-line authorization tool, NHPNet.

Services that Do Not Require a Referral
  • Chiropractic, Physical Therapy, Occupational Therapy, Speech Therapy 
  • Care provided by a specialist while inpatient
  • Family planning services
  • OB & GYN preventative and urgent care
  • Outpatient and diversionary Behavioral Health Services
  • Special Kids Special Care (SKSC) Pediatric Program 
  • Urgent and Emergent Services
Online Authorizations 
Effective September 10, 2012, most authorizations need to be submitted directly through NHP's on-line authorization tool, NHPNet. NHP will no longer accept fax requests for those services designated for transmission through NHPNet. Clinical documentation to support the medical necessity may be uploaded along with the request following the user's guide. At this time NHP will continue to accept clinical documentation by fax. 

NHPNet Registration 
You must be a registered user of NHPNet to submit online authorizations, referrals, and verify member eligibility. Please ensure staff who request authorizations and referrals have access to NHPNet. For those that want to register a site or a new site user, go to and register. For assistance please reference the NHPNet user registration guide.


Quick Start Reference Guides 
NHP has developed Quick Start guides to show you how to enter authorizations and referrals via the portal. Please review the PDFs below; should you have any questions, please don't hesitate to contact your Provider Relations Representative. 
Services Requiring Electronic Submission 
The following guide details which services will require electronic submission. 

Please stay tuned to for additional updates prior to the September 10, 2012 launch.

Maintenance 90 Program Updates

As of August 3, 2012, Neighborhood Health Plan's Maintenance 90 Program Medications have changed. In particular, many categories of behavioral health medications are now excluded from the program. The categories of medications that have been excluded include: Stimulants, Benzodiazepines, Antipsychotics, Mania medications, Tricyclic antidepressants, SSRI, SNRI, Trazodone, Bupropion, Buspirone, Gabapentin, Albuterol inhalers/nebulizer solution, Warfarin. Please note: The anti-seizure medications also used as mood stabilizers will continue in the program.


You can prescribe a 30-day supply for a new prescription prior to prescribing a 90-day supply.

Provider Payment Guideline Updates

The following Provider Payment Guidelines have been updated:


REVISED: Preventive Services Guideline  

REVISED: Evaluation & Management (E&M) Guideline  


Please read this key message letter for details.

Clinical Coverage Criteria Updates

The following Clinical Criteria are now available:


  • Infertility
  • Home Prothrombin Time Monitoring
  • CAQH Supporting Documentation

    Health Care Providers and Administrative Staff that utilize the CAQH system.

    Please be aware that starting the week of August 20, 2012, CAQH began accepting provider supporting documents via email. HCAS has worked with CAQH to make this important change that should streamline the process for document submission.

    Providers will be able to email electronic copies of their supporting documents (i.e. Authorization Attestation and Release forms, Professional Liability Insurance Policy Face Sheets, DEA Certificates, etc.) to Providers submitting supporting documents via email will be asked to utilize the attached Email Cover Sheet, which is available at, under the "Attachments" tab. HCAS has included the form as an attachment to this email but providers should use the CAQH online version to ensure that you have current version as it may change over time. CAQH has updated the Attachment page on the Online Application System (OAS) site with instructions on how to use this new feature.

    CDC Growth Charts

    The Massachusetts WIC Nutrition Program is excited to announce that, as of October 1st, nutrition staff will be utilizing the 2006 World Health Organization growth curves to assess growth patterns and determine nutritional risk among children under the age of two. This change in practice is based upon recommendations from the Centers for Disease Control and Prevention and is in response to a nationwide USDA policy change.  Although many pediatric providers are likely using the new grids, there may be some who continue to assess growth for children 0 - 24 months based on the 2000 CDC grids.  In an effort to ensure that families receive consistent messages about growth status, WIC is eager to work with MCAAP members to smoothly implement the transition to the WHO grids.  Local WIC nutrition staff will be reaching out to community providers this fall to further discuss this change.  Providers can also contact Rachel Colchamiro, Director for Nutrition Services at 617-624-6153 or for more information. 
    For access to the WHO charts and to read CDC's recommendations regarding their use, please visit
    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.