Neighborhood Health Plan
Neighborhood Health Plan Provider News
In This Issue
Benefit Coverage Clarification: Hearing Aids
NHPNet: HEDIS Measures
Corrected Claims via EDI
Clinical Coverage Criteria Updates
My NHP Profile

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

Benefit Coverage Clarification: Hearing Aids 

As of 1/1/2013, NHP provides the following coverage for Commercial Plans: Hearing aids are covered for commercially insured children through their 21st year, for the cost of one (1) hearing aid per hearing-impaired ear, up to $2,000 per hearing aid, every 36 months.  Coverage includes all services related to a covered hearing aid device, including the initial hearing aid evaluation, fitting and adjustments and supplies, including ear molds.

Coverage for the hearing aid device is limited to $2,000 per hearing aid per hearing impaired ear, every 36 months.  This limit applies to the hearing aid device only, and does not apply to the related services and supplies.  However, members may elect to purchase a more expensive hearing aid; in which case NHP would pay $2,000 and the member would pay the difference in cost above the limit of $2,000. Commercial coverage does not include batteries. Assistive listening devices are not covered for Commercial members.

Should you have any questions, please contact our Provider Service Center at 1-855-444-4NHP (4647).
NHPNet: HEDIS Measures  
When you login to NHPNet, you'll notice Key Indicators on the right side of your homepage.  Key Indicators help you manage patient care.  If you're a primary care provider, you'll see: 
HEDIS Measures (Measured over the previous year)
  • Breast cancer screening
  • DM HbA1C testing
  • Asthma management
Under Members Needing Screening/Testing, click on the count to produce a report detailing the impacted patients.

Patient Utilization
(Measured over the most recent month)
  • ER visit count
  • Generic drug dispense rate
  • Inpatient admissions  
Key Indicators appear on the right side of your NHPNet homepage. 

Corrected Claims via EDI

Did you know NHP can receive corrected claims electronically? 

Corrected Claims
NHP accepts both electronic and paper corrected claims, in accordance with guidelines of the National Uniform Claim Committee (NUCC) and HIPAA EDI standards.

Electronic Submissions
To submit a corrected facility or professional claim  electronically:
  • Enter the frequency code (third digit of the bill type for institutional claims; separate code for professional claims) in Loop 2300, CLM05-3 as either "7" (corrected claim), "5" (late charges), or "8" (void or cancel a prior claim).
  • Enter the original claim number in Loop 2300, REF segment with an F8 qualifier. For example, for claim # 12234E01234, enter REF*F8*12234E01234.
Provider payment disputes that require additional  documentation must be submitted on paper, using the Request for Review Form.

Clinical Coverage Criteria Updates  

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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