Neighborhood Health Plan
Neighborhood Health Plan Provider News
In This Issue
NDC Requirement Feb. 1st
NHPNet Eligibility Enhancements
DME Prior Authorization Changes Jan. 1st
GIC Tiering Update
Healthwise® Care Support
Pharmacy Update
My NHP Profile

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January 2013
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Please find below a list of important Neighborhood Health Plan updates.

NDC Requirement    

For services provided February 1, 2013 and going forward, MassHealth requires NHP, as a contracted MCO with the Commonwealth of Massachusetts, to collect and report NDC codes for physician-administered drug. This requirement is a result of the Affordable Care Act (ACA).

Neighborhood Health Plan will require the 11-digit National Drug Code (NDC), NDC units and unit descriptors on outpatient claims for drugs administered during a patient's visit in addition to the HCPCS code in order to be compliant with the State regulations. Providers will need to submit claims with both HCPCS and NDC codes to NHP with the exact NDC that appears on the medication packaging in the 5-4-2 digit format (i.e. xxxxx-xxxx-xx).  This coding requirement will apply to all NHP members regardless of product line.  

For services provided as of February 1, 2013, outpatient claims that include physician-administered drugs will need to be submitted with the appropriate NDC information.  Claims submitted without the applicable NDC information will reject and be subject to re-filing and timely filing limits.  

At this time, MassHealth is requiring NDC information on all Single-Source Drugs as defined by CMS, with the exceptions listed below:
  • Inpatient Claims
  • Outpatient claims that are part of a bundled rate or global fee.
  • Radiopharmaceuticals
  • Contrast media
  • Vaccines
  • 340B program drugs

340B Program Information
Please note that the MassHealth requirement to include NDC information for drugs purchased through the 340B program does not apply to MCO drugs at this time.  To indicate that the drug was purchased through the 340B program providers must add "Modifier UD" with the HCPCS code.   

MassHealth will supply a list of HCPCS that require NDC codes. This list is available here and will be posted on the NHP website at soon. This list will be updated quarterly beginning in the second quarter of CY 2013.

If you have additional questions about filing claims using the NDC number, please read MassHealth's NDC and HCPCS Frequently Asked Questions at Note, however, that MassHealth requirements around reporting NDC information are not identical to the MCO requirements. Please modify any billing instructions as appropriate. 

NHPNet Eligibility Enhancements

Effective December 28, 2012, to comply with guidelines developed by the Committee on Operating Rules for Information Exchange (CORE*), we are making enhancements to the eligibility information displayed on NHPNet.
What has changed?
As of December 28, 2012, you will see benefit information for additional covered services, when applicable.  Please view the screen shots below to get a glimpse of the added information.

For more information on these changes, please view our HIPAA 270/271 Companion Guide.

*A committee of the Council for Affordable Quality Healthcare (CAQH).

NHPNet Eligibility Information prior to December 28, 2012:  
NHPNet Eligibility Information as of December 28, 2012:

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 have 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. 

GIC Tiering SFY 2014 

Each year Neighborhood Health Plan (NHP), along with the other carriers that provide health insurance to GIC employees, works collaboratively with the GIC and their consultants on the Clinical Performance Improvement (CPI) Initiative.   

Notification of your Neighborhood Health Plan (NHP) new tier designation for the NHP Care HMO plan for the Group Insurance Commission (GIC), State Fiscal Year (SFY) 2014 have been mailed. NHP's tiered network applies to GIC member enrollees only.  

As in the past, NHP tiers their Primary Care network at the group level, in addition to the following specialties at the individual physician level.
  • Cardiology
  • Endocrinology
  • Gastroenterology
  • OB/GYN
  • Orthopedic Surgery
  • Otolaryngology
  • Pulmonology
  • Rheumatology

Step Therapy program for Second Generation Antipsychotic Medications

Effective March 1, 2013, NHP is implementing a Step Therapy program for Second Generation Antipsychotic Medications to promote the use of generic medications.  For additional information, please read the provider notice here

HealthwiseŽ Care Support

Did you know NHP's website offers Healthwise? Healthwise is an online health resource for our members providing in-depth articles and interactive tools to help NHP members make wise health decisions, stay healthy, and live well.  Below is a sample article highlighting the danger of teen substance abuse.


Teen Alcohol & Drug Abuse  

Last Revised: July 20, 2012

Author: Healthwise Staff 

What is teen substance abuse?

Many teens try alcohol, tobacco, or drugs. Some teens try these substances only a few times and stop. Others can't control their urges or cravings for them. This is substance abuse.

Teens may try a number of substances, including cigarettes, alcohol, household chemicals (inhalants), prescription and over-the-counter medicines, and illegal drugs. Teens use alcohol more than any other substance. Marijuana is the illegal drug that teens use most often. 


Why do teens abuse drugs and alcohol?
Teens may use a substance for many reasons. They may do it because:

  • They want to fit in with friends or certain groups
  • They like the way it makes them feel.
  • They believe it makes them more grown up.  

Teens tend to try new things and take risks, so they may take drugs or drink alcohol because it seems exciting.

Teens with family members who have problems with alcohol or other drugs are more likely to have serious substance abuse problems. Also, teens who feel that they are not connected to or valued by their parents are at greater risk. Teens with poor self-esteem or emotional or mental health problems, such as depression, also are at increased risk.   

To continue reading, please follow this link to our website.

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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