Neighborhood Health Plan
Neighborhood Health Plan Provider News
In This Issue
The New NHPNet Design Nov. 13th
Prior Authorization Changes Dec. 1st
DME Prior Authorization Changes Jan. 1st
Urine Drug Testing (UDT) Payment Guideline Update Dec. 1st
Clinical Coverage Criteria Updates
Provider Manual Update
Pharmacy Update - Changes Jan. 13th
Blood Pressure Awareness
Behavioral Health Screenings
Reminder: Completion of HCAS Provider Technology Adoption Survey
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November 2012
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Please find below a list of important Neighborhood Health Plan updates.

The New NHPNet Design    

On November 13, 2012 the new NHPNet design goes live.

What's changed?

We simplified it
We heard from providers that ease of use of our website helps us work better together. We have redesigned the website to further simplify your interactions with NHP and support
the management of your patients, our members.

More direct access
The e-business tools you use everyday are now only a click away. There are also enhancements that will simplify data extraction, dashboard viewing, and reporting to help you manage your practice.

No new action required
Existing users will automatically have access to the new site.
Remember your User Administrator, located at your practice, is always able to give users access to additional features and tools.

Here is a preview of the new design. Over the next couple of weeks, we will provide you with video tutorials and guides.

Please read the flyer for additional details.

Prior Authorization Changes

As we previously communicated, 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: members with a PCP at Harvard Vanguard Medical Associates (HVMA) 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.   

    DME Prior Authorization Changes

    NHP continues to consider the feedback we receive from our network to find ways to optimize efficiency and remove barriers to caring for our members.  NHP has completely realigned prior authorization requirements for many Durable Medical Equipment (DME) codes.  Effective January 1, 2013, we are significantly reducing the number of DME items which require prior authorization.   We will share the new Prior Authorization List for DME, Medical Supplies, Orthotics & Prosthetics in our December Newsletter.  

    We will continue to monitor DME services and expect to see that this change will eliminate substantial administrative burden for the network without changing utilization patterns.  Plan benefit coverage and benefit limits will not be impacted by these changes in authorization requirements.   

    Urine Drug Testing (UDT) Payment Guideline 

    As we previously communicated, 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

    Provider Manual Update 

    NHP's Provider Manual has recently undergone extensive revisions and includes important updates on doing business with NHP. This new edition of the Provider Manual has been created in a format that allows you to find the information you need quickly. 

    Pharmacy Update

    NHP members who need specialty pharmacy medicine will now see the name BriovaRx, formerly known as Medfusion/Ascend Specialty Pharmacy

    Fertility medications: Effective January 1, 2013, NHP will require the following specialty fertility medications be obtained via mail order from BriovaRx. These medications are
    expensive, can be difficult to administer, require special handling during transport, and may cause significant adverse reactions.

    To ensure an easy transition, a BriovaRx Patient Care Coordinator will contact your office for additional information necessary to enroll the member and fill the next order. We will also contact members currently taking one of the below specialty medications to explain the changes.

    Changes in preferred fertility drug status: Effective January 1, 2013, Follistim AQ will be a 1st line medication
    and Gonal-F will be a 2nd line medication. Prior to prescribing Gonal-F your patient will need to try Follistim. Please see the resource grid below to access the prior authorization form required for second line medications.

    Please note that these updates do not change the prior authorization process (if required), nor will your patient require a new prior authorization (unless authorization has expired) as part of this pharmacy switch.

    Thank you in advance for your cooperation in working with us during this transition. Please contact our Provider Service Center at 1-855-444-4NHP (4647) or BriovaRx directly at 1-800-850-9122 with any questions.

    Please read the prescriber provider notice for additional details. 

    Blood Pressure Awareness

    NHP would like to tell you about helpful resources for members with high blood pressure.

    Thumbs up for Blood Pressure Control booklet  

    Our booklet talks about things members can do to control high blood pressure like eat healthy and exercise. Members can even learn how to take their own blood pressure. To obtain a supply of Thumbs up for Blood Pressure Control booklets, please contact your Provider Relations Representative or email

    The Omron BP760 blood pressure monitor  

    It is important for members to check their blood pressure often. Some people find it helpful to check it at home or work. Members can now get their own monitor at no cost. 

    To get this monitor, members will need a prescription from their doctor for the Omron BP760 monitor. Members can take the prescription to an NHP participating pharmacy to obtain the device.

    Behavioral Health Screenings

    Neighborhood Health Plan (NHP) requires that Primary Care Providers (PCPs) offer periodic and medically necessary inter-periodic screens to members under the age of 21 in accordance with the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) and Preventive Pediatric Healthcare Screening and Diagnosis (PPHSD) Periodicity Schedules. This requirement applies to MassHealth members only. However, to minimize administrative complexities and in our continuous quality improvement efforts, NHP covers this service for all members.

    NHP reimburses one (1) screening per member per day, regardless of the number of screening tools administered for a member on a single day.

    To be eligible for reimbursement, Primary Care Providers (MDs and NPs) must use specific, clinically appropriate behavioral health screening tools accommodating different age ranges while allowing some flexibility for provider preference and clinical judgment. Additionally, procedure code 96110 must be billed with the appropriate U modifiers (U1 - U8) indicating the type of provider who conducted the screening and whether a behavioral health need was identified.

    Claims submitted without the corresponding U modifier are subject to deny.

    Please share this important change with billing and other staff as you deem appropriate. Additional information on this requirement is available within the Billing section of our Provider Manual

    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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