Neighborhood Health Plan
Neighborhood Health Plan Provider News
In This Issue
Provider Service Line Updates
Commonwealth Choice Open Enrollment
Clinical Coverage Criteria Updates
Healthwise® Care Support
Notification of Birth
My NHP Profile

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July 2013
Provider Banner
Greetings!

Please find below a list of important Neighborhood Health Plan updates.
Provider Service Line Updates    
Extended Hours

We are pleased to announce extended hours for our Provider Service Line (1-855-444-4NHP). Hours of operation are now 8am-6pm (Mon-Fri).


New Provider Service Line Prompts     

We are making enhancements to our Provider Service Line  (1-855-444-4NHP). Beginning mid July 2013, when calling our provider service line, you will receive a prompt to enter your NPI number and the Member ID. These enhancements will  assist with timely responses to your phone inquiries.   

As a reminder, our provider portal (NHPNet) remains 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. 
NHP Commonwealth Choice Open Enrollment 
Open enrollment for Commonwealth Choice will be held
7/1/13-8/15/13. NHP provides Commonwealth Choice members with access to top doctors and great wellness benefits - all at an affordable price. This includes:
  • Access to an extensive network of 68 hospitals, over 4,000 primary care physicians and 13,400 specialists.
  • Comprehensive vision services including eye exams every 12 months, free eyewear and discounts on contact lenses at all Cambridge Eye Doctors locations.
  • NHP is the only plan that includes preventative adult and pediatric dental coverage through our partnership with Delta Dental of Massachusetts. 

Members who are currently enrolled in Commonwealth Choice may continue with their plan. New members may elect to enroll in the Neighborhood Health Plan Commonwealth Choice plans by calling the Health Connector at 1-877-623-6765 or visiting www.MAhealthconnector.org.   

   

Clinical Coverage Criteria Updates      
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 COPD (Chronic Obstructive Pulmonary Disease).

COPD's Effect on the Lungs
Last Revised: November 29, 2011
Author: Healthwise Staff

COPD's effect on breathing

In COPD, the airways of the lungs (bronchial tubes) become inflamed and narrowed. They tend to collapse when you breathe out and can become clogged with mucus. This reduces airflow through the bronchial tubes, a condition called airway obstruction, making it difficult to move air in and out of the lungs.

The inflammation of the bronchial tubes makes the nerves in the lungs very sensitive. In response to irritation, the body forces air through the airways by a rapid and strong contraction of the muscles of respiration-a cough. The rapid movement of air in the breathing tubes helps remove mucus from the lungs into the throat. People with COPD often cough a great deal in the morning after a large amount of mucus has built up overnight (smoker's cough).

The oxygen and carbon dioxide exchange

The lungs are where the blood picks up oxygen to deliver throughout the body and where it disposes of carbon dioxide that is a by-product of the body processes. COPD affects this process.

Emphysema can lead to destruction of the alveoli, the tiny air sacs that allow oxygen to get into the blood. Their destruction leads to the formation of large air pockets in the lung called bullae. These bullae do not exchange oxygen and carbon dioxide like normal lung tissue. Also, the bullae can become very large. Normal lung tissue next to the bullae cannot expand properly, reducing lung function.

Chronic bronchitis affects the oxygen and carbon dioxide exchange because the airway swelling and mucus production can also narrow the airways and reduce the flow of oxygen-rich air into the lung and carbon dioxide out of the lung.

The damage to the alveoli and airways makes it harder to exchange carbon dioxide and oxygen during each breath. Decreased levels of oxygen in the blood and increased levels of carbon dioxide cause the breathing muscles to contract harder and faster. The nerves in the muscles and lungs sense this increased activity and report it to the brain. As a result, you feel short of breath.

For additional details please go to the Healthwise page.
Notification of Birth Reminder
As you may be aware, MassHealth's enrollment process for newborns born to mothers enrolled in a Managed Care Organization such as NHP requires that the facility notify their Enrollment unit via the Notification of Birth (NOB) form. This MassHealth proprietary form captures demographic information for both mother and child, in addition to confirming the mother's health plan selection for the newborn.

We would like to remind network facilities of the critical need to submit the fully completed NOB to MassHealth timely and indicating the health plan chosen by the mother. Failure to properly notify MassHealth often results in retroactive enrollment changes and the associated post-payment recoveries. While health plans cannot notify MassHealth directly of these newborns, we  are currently reviewing the process for alerting facilities of babies born to NHP enrolled members in hopes of increasing the notification compliance rate.
 
Please share this information with relevant personnel within your organization. For questions on completing the NOB, please contact Provider Relations at prweb@nhp.org.

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 

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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