Neighborhood Health Plan
Neighborhood Health Plan Provider News
In This Issue
Provider Enrollment Updates
NHPNet Online Auths - Continued Stay Requirements
Provider Service Line Updates
Expansion of NHP Service Area
Pharmacy Update
2013 Office Manager Satisfaction Survey
Healthwise® Care Support
Clinical Coverage Criteria Updates
Massachusetts eHealth Institute (MeHI) Spring 2013 Regional HIT Meetings
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May 2013
Provider Banner

Please find below a list of important Neighborhood Health Plan updates.
Provider Enrollment Updates   
New Email Address: PEC@NHP.ORG
Starting June 1, 2013, we will be launching a new email address - PEC@NHP.ORG - for the following Provider Enrollment Transactions:
  • Submission of HCAS forms
  • Termination requests
  • Effective date inquiries
  • Requests to change PCP panel status
  • Provider demographic changes
  • Requests to become a participating provider  

The HCAS form will be updating over the next few weeks to reflect the new email address. 


Enhanced Provider Directory
Stay tuned in the coming weeks for an enhanced version of our online provider directory

NHPNet Online Authorizations - Continued Stay Requirements 

As we previously communicated, effective Sept. 10, 2012, NHP requires all Acute Inpatient authorization requests to be submitted online through NHPNet.  In addition to submitting the initial request through NHPNet, all continued stay authorizations must also be submitted through the portal and clinical notes can also be uploaded at the same time.  Below is an excerpt from the User Guide explaining the process.


Edit a Service Request (Use for Concurrent Review)
  • On the main screen, click on Revise Auth/Referral.
  • Screen will default to the Status tab.
  • Use any combination of information for the search criteria and click Search.
NHPNet Concurrent Review 1

Please go to page 10 of User Guide for further instructions (
Provider Service Line Updates    
Beginning June 1, 2013, our Provider Service Line  (1-855-444-4NHP) will be updated to ask for an NPI and Member ID at the beginning of your call.  This will help improve service and expedite your request.  Some prompts may change so please listen to the them when you need to call.

We know your time is valuable and we hope that this change will yield a positive impact in doing business with NHP in the future.

As a reminder, our provider portal (NHPNet) is available 24 hours a day, 7 days a week to provide access to many transactions within seconds and without a dependency on Provider Service staff. Thousands of NHP network providers are already taking advantage of this provider self-service option to submit authorizations and referrals, check eligibility, claims and authorization status, preview/download copies of NHP Explanation of Payment, and process PCP assignment corrections, to name just a few! 
Expansion of NHP Service Area
NHP recently received approval from the Division of Insurance to expand its coverage into Greater Plymouth County.

"We are excited about our expansion into Plymouth County," said NHP President and CEO Deborah Enos. "For many years, individuals and businesses in Plymouth County have asked to join NHP because of our emphasis on affordable and high quality health care, and we are pleased to be able to offer our plans in this region."

Under this new expansion, Plymouth County residents will be able to take advantage of NHP's large provider network, which includes the top Boston hospitals, Jordan Hospital and Jordan Physician Associates, among other primary care physicians and specialists.

NHP's mission is to promote the health and wellness of its members, and to help ensure equitable, affordable health care for the diverse communities it serves.

Click here for the full press release. 

Pharmacy Update  

Effective July 1, 2013, Neighborhood Health Plan (NHP) will be making the following pharmacy benefit changes:

Proton Pump Inhibitors (PPI)
  • Prilosec OTC will be removed from the pharmacy benefit and will no longer be covered. NHP will cover prescription omeprazole, the active ingredient in Prilosec OTC. Prescription omeprazole will be the first line agent in NHP's PPI step therapy program. Step Therapy is an automated case review based on established guidelines from the NHP Pharmacy and Therapeutics Committee, as well as the individual member's NHP pharmacy profile. This process occurs with a pharmacy claims submission and does not require provider intervention if prior NHP pharmacy claims indicate use of the first line and/or second line medications.
  • The copay for prescription omeprazole will remain the same and copays are determined by the NHP plan your patient has. Prescription omeprazole will be covered as a generic or a Tier 1 drug. For the most up to date information, visit and click on Drug Lookup under Quick Links.
HMG-CoA reductase inhibitors Step-Therapy Program
  • Crestor will be moved from a second-line drug to a third-line drug. For treatment na´ve patients, Crestor will now be approved if your patient has tried simvastatin AND atorvastatin in the previous 360 days.
  • This change is applicable to existing patients on Crestor as well as patients who have not taken Crestor previously. Patients who are currently taking Crestor 40mg can remain on Crestor 40mg and do not have to try atorvastatin.
  • A dosing reference of comparative statin potencies (LDL lowering effect) is below.
  • Patients will have a lower generic copay if they can take atorvastatin.
  • To obtain a prior authorization for Crestor or a second or third-line drug, please contact Catamaran at 1-800-918-7550 to request a prior authorization, or Download an HMG-CoA Reductase Inhibitor fax form ( and send to 1-800-918-7542.

Members may be contacting you for a new prescription of either prescription omeprazole or atorvastatin if they need to make the change from Prilosec OTC or Crestor. If you have questions, please call the NHP Provider Service Center at 1-855-444-4647.

2013 Office Manager Satisfaction Survey 

Each year, Neighborhood Health Plan, with assistance from the independent market research firm Market Measurement, Inc., conducts a telephone survey to identify the ways in which we can better serve your needs.  Consider the following:
  • Your responses will remain completely confidential, as only summary data will be shared with Neighborhood Health Plan
  • This is your opportunity to ensure our action planning process focuses upon what is most important to you and your relationship with Neighborhood Health Plan
  • The interview will take only about ten minutes
  • The study will be conducted between May and June. 
Thanks in advance for your support!

Healthwise« Care Support: Allergies  

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 information below focuses on Allergies.

Allergies: Avoiding Outdoor Triggers
Author: Healthwise Staff
Last Revised: June 30, 2011


Allergic rhinitis Click here to see more information. causes symptoms of sneezing, congestion, and a runny nose. But you can control these symptoms with medicine and by avoiding the things that cause them (allergensClick here to see more information.). If you are allergic to outdoor allergens, such as pollen and mold, you don't have to give up an outdoor life. You just need to know when and how to take precautions.

By taking these precautions, you may have fewer or less severe symptoms.

What do I do first?

To avoid allergens, you need to know what you are allergic to. If you are allergic to outdoor pollens, you may have symptoms only at certain times of the year. If you have symptoms in:
  • Spring, you are probably allergic to tree pollens.
  • Summer, you are probably allergic to grass and weed pollens.
  • Late summer and fall, you probably are allergic to ragweed or other weed pollens, such as tumbleweed or sage.
Always talk to your doctor about your symptoms. He or she can help you find out what allergens are causing them and where and when they are likely to be worse. When you know this, you can find ways to avoid the allergens.

For example, you may be allergic to a type of pollen that is present in a certain season or at a certain time of day. You can then decide when and how to avoid contact with these allergens while outdoors and how to prevent them from entering your home.

Please click here to continue reading.

Clinical Coverage Criteria Updates  

Massachusetts eHealth Institute (MeHI) Spring 2013 Regional HIT Meetings 

The Massachusetts eHealth Institute (MeHI) will be hosting Regional Health Information Technology (HIT) regional meetings throughout 2013. These have been created for all healthcare organizations and their teams to learn more about the Commonwealth's Health Information Technology initiatives and funding opportunities. Each meeting will host breakout learning sessions to provide comprehensive, actionable information to support successful provider technology adoption and optimization.

MeHI is responsible for advancing the dissemination of health information technology and facilitating the implementation and use of electronic health records systems by all providers in the state. Hosted by MeHI, the Commonwealth's leading HIT resource, Spring 2013 MeHI Regional HIT Meetings will bring together healthcare leaders, providers, and their teams to discuss:

Chapter 224 Cost Containment Legislation

Physician Licensure Requirements, Behavioral Health, and Long Term Care Initiatives


Health Information Exchange

The Last Mile: Connection, Education, and Optimization


The Medicaid EHR Incentive Program

Expanded Eligibility Requirement and Important 2013 Stage 1 Changes 


Events are free to attend. Seats are limited.
Register by location below
Call 1-855-MASSEHR (1.855.627.7347)
Email to  


May 14th - Southeast 

Holiday Inn Taunton

700 Myles Standish Boulevard

Taunton, MA  02780 

May 16th - West
Sheraton Springfield Monarch Place

HotelOne Monarch Place

Springfield, MA  01144 

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 

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