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Looking for a copy of a previous E-Newsletter? All prior editions are located at this link.
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The 2012 Quarter 3 Hospital Admissions Report is now available onNHPNet! Login today to see Clinical Reports relevant to your site.
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To view all NHP Provider Payment Guidelines just click here!
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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!
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Greetings!
Please find below a list of important Neighborhood Health Plan updates. |
NDC Requirement - Important Update!
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Important Update to February 1, 2013 NDC Coding RequirementNHP will reject claims that do not meet the following requirements for NHP Mass Health members only. Providers will need to submit claims for HCPCS on this list 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). NHP will continue to accept NDC for all lines of business. As a reminder, if you have a bundled rate or global fee arrangement for outpatient claims with NHP then your claims will be accepted without NDC codes. Additional DetailsNeighborhood 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. 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. Mass Health claims submitted without the applicable NDC information will be rejected and 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 InformationPlease 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 posted on the NHP website at http://www.nhp.org/pages/providers_pharmacy.aspx. 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 http://www.mass.gov/eohhs/gov/newsroom/masshealth/providers/national-drug-code-ndc-requirements-for.html.
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NHPNet Enhancements
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Authorization/Referral Search Status
We've added a new feature to NHPNet so that you can now search for authorization/referral status by either the auth/referral ID or member ID directly from the home page!
Simply click on the Lookup By drop-down and choose your preferred search method!
How to Access Additional Sites from your existing NHPNet account
One of the frequent needs we hear from providers is the ability to access more than one site through NHP Net. If you need to access more than one site, you do not need to create additional login IDs! Using your existing login, you can request access to additional sites by following the simple steps outlined in the following guide: How to Access Additional Sites using an existing NHPNet account.
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DME Prior Authorization Update
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In follow up to our recent communication regarding prior authorization requirements for many Durable Medical Equipment (DME) codes, we'd like to clarify that the codes below will continue to require prior authorization.
Assistive Listening Device
Enteral Formulae
- B4102
- B4103
- B4104
- B4149
- B4150
- B4152
- B4153
- B4154
- B4155
- B4157
- B4158
- B4159
- B4160
- B4161
- B4162
Prosthesis Please stay tuned to the Provider section of NHP.org for an updated DME prior authorization list.
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Online Authorizations & Referrals
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It's been nearly 5 months since we launched our online authorization and referral tool on NHPNet! Remember, not only can you submit initial authorizations and referrals online, but you can also revise them by following the steps outlined in our user guides, available here:
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Provider Directory Questionnaire
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NHP is dedicated to connecting our members with NHP providers that meet their specific needs. To make these connections, it is vital that our provider directory and our member service team have the most accurate information about provider practices. This is especially important for our members with disabilities.
To better service our members, we are revising our provider directory to include specific information about how your site can accommodate members with disabilities.
Those practices that complete the entire questionnaire will be entered into a drawing to win a new iPad Mini. We will randomly select a questionnaire and contact you directly if you have won. The winning practice location will also be announced in our Monthly eNewsletter.
Stay tuned in the coming weeks for additional details.
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PCP Panel Status
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Have you logged onto NHPNet recently to verify the accuracy of your provider roster and PCP panel status? NHP strongly recommends frequent review of NHPNet's Provider Roster Report to ensure we have all of your providers linked to your group and that we are listing their panel status correctly.
To view the report, logon to NHPNet and click on the Reports tab. From there, select Provider Roster Report from the drop-down menu and then click on the Site Provider Roster Report.
If you notice any discrepancies within the report, please notify your Provider Relations Representative or send an email tlo prweb@nhp.org.
If you have access to NHPNet and you are not able to view the Site Provider Roster Report, please contact your User Administrator and ask them to grant you access.
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HealthwiseŽ Care Support
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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. The article below focuses on some of the challenges impacting people with disabilities.
Independent Living for People With Disabilities
Last Revised: Feb. 17, 2012
Author: Healthwise Staff
Some teens and young adults with disabilities such as cerebral palsy or Down syndrome need extra help preparing for independent living.
Major independent living skills include preparing meals, managing money, knowing when and where to seek medical care, and using public transportation.
Some adults with disabilities live at home until their parents pass away or are no longer able to care for them. These older adults may need the same level of training for independent living that teens and young adults require.
Community agencies help people with disabilities make the transition to independent living. Specially designed living spaces help some teens and young adults to live alone. Other teens and young adults choose to live in group homes, preferring the comfort of being around people and knowing that extra help is available if they need it.
Some people find it helps to:
- Talk with other parents about how they have helped their children with disabilities adjust to independent living.
- Find out about local agencies that help people with disabilities to live on their own.
- Get in touch with an occupational therapist, who is trained to prepare people with disabilities for independent living.
- Visit group homes in your community, and talk with people who live there.
Click here to access Healthwise for additional educational resources.
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Reminder: Completion of HCAS Provider Technology Adoption Survey
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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 www.hcasma.org/Survey.aspx
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 www.hcasma.org/Survey.aspx.
*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.
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| 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
prweb@nhp.org
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| 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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