Neighborhood Health Plan
Neighborhood Health Plan Provider News
In This Issue
Partners Affiliation
Prior Authorization Changes
Urine Drug Testing (UDT) Payment Guideline
Clinical Coverage Criteria Updates
OptumHealth Vision Name Change
Pharmacy Update
Coming Soon: A New NHPNet!
Reminder: Completion of HCAS Provider Technology Adoption Survey
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Clinical Coverage Criteria are now available!  Please click here to access.

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

Partners Affiliation  

NHP and Partners HealthCare affiliate with a combined vision for care

Effective October 1, 2012 Neighborhood Health Plan (NHP) becomes a member of Partners HealthCare (Partners). NHP and Partners share a dedication to ensuring and continuing to deliver high quality care to our members. Together, NHP and Partners will have enhanced ability and flexibility to develop innovative patient and family-centered models of care and craft new initiatives aimed at better managing care of complex conditions, especially for underserved populations.

As part of the affiliation, a grant program will be created to benefit community health centers (CHCs).  Grant funding will be targeted toward projects that will improve the infrastructure of and support expanded programs for CHCs.

The affiliation with Partners will enhance NHP's ability to carry on its mission as a not-for-profit safety net managed care organization. The work that we do today in support of our members and in partnership with our provider community will continue on.

Prior Authorization Changes

Effective December 1, 2012, the following services will no longer require prior authorization:


  • Outpatient and home Occupational Therapy (OT)  
  • Outpatient and home Physical Therapy (PT)
  • Outpatient and home Speech Therapy (ST)
  • Most Surgical Day Care (SDC)

    Please note: HVMA members seeking PT/OT/ST services outside of HVMA will continue to require authorization. 


    For a list of SDC services that will continue to require authorization please see the Notice and Fact Sheet . For a complete listing of services that require prior authorization and/or referrals, please reference the Prior Authorization Grid.

    Urine Drug Testing (UDT) Payment Guideline 

    Effective December 1, 2012, Neighborhood Health Plan (NHP) is revising our Payment Guideline for Urine Drug Testing (UDT). Providers and independent laboratories submitting for UDT services must have the appropriate level Clinical Laboratory Improvement Amendments (CLIA) certification on file with NHP for the specific service(s) rendered. Please refer to the provider payment guideline for NHP's CLIA certification requirements and allowable codes. Any provider billing for UDT services that do not have a valid CLIA certification on file or the appropriate CLIA level will not be reimbursed for services. We will contact you directly if we do not have a valid CLIA on file.

    NHP will reimburse up to 20 medically necessary urine drug-test screenings, for both G0431 and G0434 combined, per member, per benefit plan, to detect the parent drug and/or its metabolite(s) to demonstrate use of prescription medications and illegal substances of concern for treatment purposes.

    NHP will not reimburse single drug class testing on the same date of service as a drug screening panel test. These include but are not limited to testing exclusively for barbiturates, opiates, ethanol, or benzodiazepine classes. Testing for non-medical purposes is not a covered benefit and will not be reimbursed.


    For additional details and a list of codes that will be reimbursed, please read the notice.  You can view a copy of the new payment guideline here

    Clinical Coverage Criteria Updates

    The following Clinical Criteria are now available:

    OptumHealth Vision Name Change

    OptumHealth Vision Plan is now Spectera Vision Plan.  Spectera covers the vision benefit for NHP Commonwealth Care members.  The Spectera website is available at

    Pharmacy Update

    Our pharmacy benefit manager, MedMetrics Health Partners has changed its name to Catamaran.  The name of our mail order pharmacy will also change to Catamaran Home Delivery.

    Only the names are changing.  Pharmacy services remains the same.  Member ID cards are still current, even though they do not have the Catamaran name on it.

    Coming Soon: A New NHPNet!

    We will be launching a redesigned NHPNet on Monday, November 12, 2012. The new NHPNet offers improved performance of some of NHPNet's current features in addition to new functionality (Key Indicators, Dashboards) plus a new look and feel consistent with our corporate image.  Your existing login credentials will allow you to login to the newly designed site. 

    Please stay tuned to NHPNet in the coming weeks for additional updates, including a new walk-through guide and video tutorials to enhance your NHPNet experience.

    Remember, as an NHP provider, NHPNet is your primary method of doing business with NHP.


    Reminder: Completion of HCAS Provider Technology Adoption Survey

    As previously communicated in the June E-Newsletter, health plans are required to collect statewide provider technology use information in order to meet All-Payer Claims Database requirements established by the Massachusetts Division of Health Care Finance and Policy. To support its member health plans* to comply with the Division's requirement, HealthCare Administrative Solutions (HCAS) has extended the submission period for completing the survey.


    We strongly encourage all providers to complete the survey at your first convenience. The survey, which takes only a short time to complete, assesses providers' use of the following technologies:

    • Electronic Health Records
    • Electronic Prescribing Systems
    • Practice Management Systems
    • Patient Portals
    • Participation in information exchanges to transmit health data (such as transmission of immunization data, test results, patient allergy information)
    • Provider use of eVisits

    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 and complete the Provider Technology Adoption Survey, please visit  


    Please note that large group practices and hospitals may elect to submit survey responses for all of their providers via a spreadsheet, rather than completing the online survey for each individual provider. This spreadsheet and accompanying group authorization and release form are also available at


    *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

    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.
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