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Greetings!
Please find below a list of important Neighborhood Health Plan updates. |
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Mid-Level Provider Reimbursement
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Effective October 1, 2013, NHP will update the fee schedule for non-physician practitioners for the following lines of business: MassHealth, Community Medical Alliance (CMA), and Commonwealth Care. Reimbursement to non-physician practitioners for these products will be at 85% of the applicable physician fee schedule. Non-physician practitioners include:
- Certified Professional Midwives (CPM)
- Certified Nurse Midwives (CNM)
- Nurse Practitioners (NP)
- Physician Assistants (PA)
- Certified Registered Nurses (CRN)
- Clinical Nurse Specialists (CNS)
Billing for Non-Physician Practitioners: - Nurse practitioners and physician assistants rendering professional services independently of a physician are required to submit the claim with his/her individual NPI.
- Services billed under the NPI of a supervising physician, append the correct modifier to the claim service line. These modifiers include, but are not limited to:
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Modifier
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Description
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GF
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Non-physician (e.g. nurse practitioner, certified registered nurse, clinical nurse specialist, physician assistant) services in a critical access hospital
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QS
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Monitored anesthesiology care services (can be billed by a qualified non-physician anesthetist or a physician)
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QX
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Qualified non-physician anesthetist with medical direction by a physician
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QY
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Medical direction of one qualified non-physician anesthetist by an anesthesiologist
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AS
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Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
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SA
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Nurse practitioner rendering services in collaboration with a physician
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Commonwealth Choice Open Enrollment Reminder
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Open enrollment for Commonwealth Choice will be held until 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.
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Affordable Care Act Update
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National health care reform, or the Affordable care act (ACA), is designed to provide millions of Americans access to affordable health care. Although many aspects of the ACA are modeled after the Massachusetts health care reform of 2006, we still have some work ahead of us to comply with the new requirements. Here are some highlights of things to come that may impact your Neighborhood Health Plan (NHP) members:
Updates Include:- Commonwealth Care will end on 12/31/13
- Commonwealth Choice will end on 3/31/14
- Members who earn up to 133% of the Federal Poverty Line (FPL) may now qualify for Medicaid
- Some members may qualify for tax credits or additional subsidies if they purchase a plan through the Massachusetts Health Connector
Federal Open Enrollment: - 10/1/13 - Open enrollment begins for individuals, families, and small groups. This is an active open enrollment that requires members to determine if they qualify for Medicaid or to select an ACA compliant plan.
- 12/31/13 - Commonwealth Care ends and members must select a new plan prior to this date to avoid a disruption in coverage.
- 3/31/14 - Federal open enrollment ends. Commonwealth Care members who did not select a plan prior to 1/1/14 can enroll in a new plan until this date (with an effective date of the 1st of the following month). Commonwealth Choice members must select a new plan before their plan end date to avoid a disruption in coverage.
Current members and new members to NHP can sign up for an ACA compliant plan by contacting the Health Connector at 1-877-623-6765 or visiting www.MAhealthconnector.org.
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We are pleased to announce that BriovaRx, our vendor for certain injectables or specialty medications, will now be our specialty vendor for Synagis as well. NHP will be covering the cost of the injection as well as the administration of Synagis throughout the respiratory syncytial virus (RSV) infection season (November through March) only if obtained from BriovaRx Specialty Pharmacy. Synagis and all supplies necessary for the administration will be shipped out and delivered to your office within 24 to 48 hours after ordering. NHP can be billed for administration of the drug.
Learn more about specific details on authorization criteria, how to request an authorization, and the approval process.
If you have any questions about this process, please call the NHP Provider Service Center at 855-444-4NHP (4647) (toll-free).
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ipad Mini Winner
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Thank you to all participants who completed the 2013 NHP Wait Time Access Survey. This survey helps NHP better understand the member wait time experience at provider offices and supplies us with required reporting information to NCQA. All participants were entered into a drawing to win an ipad Mini.
Congratulations to Neal Stephany of Pediatric Health Care Associates for being selected to win!
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Clarification!
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Over the past few weeks, Neighborhood Health Plan received provider inquiries regarding Healthfirst of New York's acquisition of Neighborhood Health Providers of New York. For clarification, Neighborhood Health Plan is not associated with either Healthfirst or Neighborhood Health Providers of New York. There is no impact to Neighborhood Health Plan's business operations with our providers or to the relationship we have with our members. 
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Clinical Coverage Criteria Updates
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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 Osteoporosis. Osteoporosis Risk FactorsLast Revised: November 6, 2012
Author: Healthwise Staff
The risk of getting osteoporosis increases with age as bones naturally become thinner. After age 30, the rate at which your bone tissue dissolves and is absorbed by the body slowly increases, while the rate of bone building decreases. So overall you lose a small amount of bone each year after age 30. In women, bone loss is more rapid and usually begins after monthly menstrual periods stop, when a woman's production of the hormone estrogen slows down (usually between the ages of 45 and 55). A man's bone thinning typically starts to develop gradually when his production of the hormone testosterone slows down, at about 45 to 50 years of age. Women typically have smaller and lighter bones than men. As a result, women develop osteoporosis far more often than men. Osteoporosis usually does not have a noticeable effect on people until they are 60 or older. Whether a person develops osteoporosis depends on the thickness of the bones (bone density) in early life, as well as health, diet, and physical activity later in life. Factors that increase the risk for osteoporosis in both men and women include: - Having a family history of osteoporosis. If your mother, father, or a sibling has been diagnosed with osteoporosis or has experienced broken bones from a minor injury, you are more likely to develop osteoporosis.
- Lifestyle factors. These include:
- Smoking. People who smoke lose bone density faster than nonsmokers.
- Alcohol use. Heavy alcohol use can decrease bone formation, and it increases the risk of falling. Heavy alcohol use is more than 2 drinks a day for men and more than 1 drink a day for women.
- Getting little or no exercise. Weight-bearing exercises-such as walking, jogging, stair climbing, dancing, or lifting weights-keep bones strong and healthy by working the muscles and bones against gravity. Exercise may improve your balance and decrease your risk of falling.
- Being small-framed or thin. Thin people and those with small frames are more likely to develop osteoporosis. But being overweight puts women at risk for other serious medical conditions, including type 2 diabetes, high blood pressure, and coronary artery disease (CAD).
- A diet low in foods containing calcium and vitamin D.
- Having certain medical conditions. Some medical conditions, such as hyperthyroidism or hyperparathyroidism, put you at greater risk for osteoporosis.
- Taking certain medicines. Several medicines, such as corticosteroids used for long periods, cause bone thinning.
- Having certain surgeries, such as having your ovaries removed before menopause.
Other risk factors for osteoporosis may include: - Being of European and Asian ancestry, the people most likely to have osteoporosis. People of African ancestry are least likely.
- Being inactive or bedridden for long periods of time.
- Excessive dieting or having an eating disorder, such as anorexia nervosa.
- Being a female athlete, if you have infrequent menstrual cycles due to low body fat.
Women who have completed menopause have the greatest risk for osteoporosis because their levels of the estrogen hormone drop. Estrogen protects women from bone loss. Likewise, women who no longer have menstrual periods-either because their ovaries are not working properly or because their ovaries have been surgically removed-also can have lower estrogen levels. For additional details please go to the Healthwise page.
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Thank You!
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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
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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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