Neighborhood Health Plan
Neighborhood Health Plan Provider News
In This Issue
Vision Services Eff. May 1, 2013
NHPNet Claims Status
Healthwise® Care Support
Spinal Surgery Criteria Checklist
Pharmacy Drug Lookup Tool
Reminder: Completion of HCAS Provider Technology Adoption Survey
My NHP Profile

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

Vision Services  

Important Notice: Vision Services
  • New Vision Service Payment Policy Guideline
  • New Optometry Fee Schedule
  • Update to Payment Policy - Refraction Services
Effective for services rendered on or after May 1, 2013, NHP will implement a new MassHealth fee schedule for our contracted Optometry providers. A sample fee schedule was mailed recently to our Optometry network.

Refraction Services
Also, effective May 1, 2013, for all lines of business, CPT code 92015 - determination of refractive services, will be reimbursed only as part of the post operative cataract treatment when billed with the appropriate diagnosis code. For additional information regarding this change, please reference the Vision Service Payment Policy Guideline (available by 4/1/13).
NHPNet Claims Status 
NHPNet is your primary point of contact when you need to check claim status with NHP.  Only limited claim status can be obtained by calling our Provider Service Center.

We've put together an interactive PowerPoint presentation detailing the simple steps required to check claims status.  Additionally, we have a step-by-step training tool as a resource to enhance your experience.

Remember to use the grid below to confirm status reasons when using NHPNet

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.  The article below focuses on Sexually Transmitted Infections in Women.

Sexually Transmitted Infections: Symptoms in Women
Author: Healthwise Staff
Last Revised: December 8, 2010

If you develop symptoms of a Sexually Transmitted Infection, it is important to be evaluated by a health professional soon after your symptoms start. Symptoms of an STI include:

  • A change in vaginal discharge (thicker, discolored, or bad-smelling) over a period of several days to 2 weeks.
  • Pain, burning, or itching while urinating that lasts more than 24 hours.
  • Pain during sexual intercourse.
  • Pain or a feeling of heaviness in the pelvic or lower abdominal area.
  • Itching, tingling, burning, or pain on or around the genitals.
  • Sores, lumps, blisters, rashes, or warts on or around the genitals or anus.
  • Vaginal spotting or bleeding after sexual intercourse.
  • General symptoms of an infection, such as fever and fatigue or lack of energy.
  • Sores in the throat.

Many STI symptoms will go away or change quickly. This does not mean that the STI has gone away. It will be harder for your health professional to diagnose your STI after the symptoms have changed. A delay in being evaluated may lead to a more serious illness.

For additional details please go to the Healthwise page.

Spinal Surgery Criteria Checklist 

When requesting a spinal surgery authorization from NHP, it's important to review the Spinal Surgery Criteria Checklist prior to submitting the request to ensure all necessary materials are included with your request.  Please remember the turn-around-time for reviewing such requests is 14 calendar days from the date all required materials are received.

Prior Authorizations for spinal surgery can only be submitted online through NHPNet

Pharmacy Drug Lookup Tool

You will notice a new look and feel to NHP's Drug Lookup Tool effective 3/15/13.  Member and providers will continue to use the Drug Lookup Tool to determine if a drug is covered by NHP and what tier (copayment), or restrictions (PA, step-therapy, quantity limit, etc) apply.  You can also get important product information (side effects, uses, storage instructions for missed doses, etc) about any drug.


You will be required to select a member's plan before searching for a drug.  The member's plan is located on their NHP ID card.  If you're not sure which plan your patient has, logon to NHPNet today to confirm eligibility and benefit information.


Under the More Info section of the new tool, you can obtain detailed information about NHP's Specialty Pharmacy program and 90-day program.

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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