Neighborhood Health Plan
Neighborhood Health Plan Provider News
In This Issue
Pharmacy Update Jan. 1st
Prior Authorization Changes Dec. 1st
DME Prior Authorization Changes Jan. 1st
NHPNet e-tools EOP's
Urine Drug Testing (UDT) Payment Guideline Update Dec. 1st
Online Clinical Reports
HCAS Provider Technology Survey
My NHP Profile

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The 2012 Quarter 2 Hospital Admissions Report is now available on NHPNet!  Login today to see Clinical Reports relevant to your site.

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December 2012
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Please find below a list of important Neighborhood Health Plan updates.
Pharmacy Updates 



BriovaRx (formerly known as Med fusion/Ascend) specialty pharmacy will replace CuraScript in providing specialty medication to members. The transition started in August, 2012 and will be mandatory effective January 1, 2013.


Also, effective January 1, 2013, NHP will require members to obtain via mail order the following specialty medications from BriovaRx. These medications are expensive, can be difficult to administer, require special handling during transport, and may cause significant adverse reactions if not transported appropriately.





































NHP Formulary Drug Lookup Tool   


Our Drug Lookup is a searchable da­tabase designed to provide information about NHP's drug coverage. It provides the following information   

  • Copay Information (drug tier)
  • Drug coverage per product type
  • Availability of drug through NHP's Access90 Program
  • Availability of drug through NHP's Mail Order Program  

To access the tool please click here.  


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: NHP members with an HVMA PCP seeking outpatient or home-based PT/OT/ST services from a non-HVMA provider will continue to require authorization.    


    It is important to verify benefits prior to rendering services.   


    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. To access the list of items that will continue to require authorization click here.

    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.   

    NHPNet e-tools - Feature Highlight

    Explanation of Payment - EOP  

    NHPNet offers quick and easy access to current and historical Explanation of Payment (EOP).  You can obtain copies of EOP's dating back to 2008.  Please utilize this easy online feature by accessing our secure provider portal, NHPNet.      

    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

    Online Clinical Reports 

    NHP provides its primary care network with a wealth of clinical resources to help in effectively managing patient care. This provision of timely, actionable site and patient-level data allows PCPs to download electronic versions of various reports and manipulate the data based on the specific needs of their practice.  Access to the data is entirely at the discretion of
    the provider office. To protect the confidentiality of our members and due to the sensitive contents of these reports, providers are strongly encouraged to grant role-based access only and review user permissions regularly. 

    Frequently utilized reports found on NHPNet

    Asthma Site Summary Report

    Key Measurements for a primary care site for asthma care quality measures compared to the best achievable performance results for the most recent quarter.  


    Diabetes Screening Rates A graphical report showing the screening rates of recommended tests for diabetes for the primary care site compared to a benchmark rate of NHP overall.

    Have You Seen Me? Detailed report listing members between the ages of 1-18 who did not have a well child visit in the past year.

    Have You Immunized Me?
    Detailed report listing members between the ages of 18 and 24 months of age during the past quarter.

    Mammography A report of female members between the ages of 40 and 74 who have not had a mammogram in the past year.

    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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