Neighborhood Health Plan
Neighborhood Health Plan Provider News
In This Issue
Technology Updates
NHPNet Functionality Reminders
Lifting the Referral Requirement for Routine Vision
Affordable Care Act Update
Seizures Program
My NHP Profile

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October 2013
Provider Banner

Please find below a list of important Neighborhood Health Plan updates.
Technology Updates 
System Enhancements
As previously announced, we are pleased to share the following enhancements starting October 1:
  • - Click Here to find out more
  • Provider Directory - Click Here to find out more 
  • New Member Portal (see below screenshot)


Cost Transparency Tools
Members now have access to a new cost estimator form, located on the member portal. To request a cost estimate for a procedure/service, members can enter in their provider's information and related procedure/service information. NHP will generate an estimate for the selected service within 2 business days.

Coming next year, NHP is partnering with Castlight Health to provide our members with an enhanced online cost estimator. This tool will provide instant cost estimates so members have access to information that will help them understand their potential cost.
Please note that these tools will not be used to make recommendations on what services or providers the member should seek. Estimates are based on the information provided. Changes to the requested service, coding, member eligibility, provider contracting, and other factors may influence the actual costs.

Electronic Funds Transfer (EFT)
By January 1, 2014, NHP will offer our providers the capability to receive EFT payments. With this service, providers will receive their payments faster and securely. You will no longer need to manually deposit paper checks. To administer the registration process, NHP will be partnering with Alegeus Technologies. Stay tuned for more.
835 Electronic Remittance Advice (ERA)
In addition to signing up to receive EFTs, providers will also have access to sign-up online to receive ERAs. All current ERA providers will stop receiving paper EOPs on February 1, 2014. Providers who sign up after January 1, 2014, will stop receiving paper EOPs after 31 days.

999 EDI Transmission
On October 1st, NHP will be replacing the 997 transaction with the standard EDI 999. These transactions are used as acknowledgment that a file was received, such as a claim, and is standardized for all payers. The 999 will inform the provider whether the transaction was accepted, accepted with errors, or rejected.
NHPNet Functionality
View Explanation of Payments (EOP)
NHPNet users have the ability to view their organization's electronic EOPs. To access EOPs, the user will enter in the Check Date in the appropriate field (see below) and press "go".

Lifting the Referral Requirement for Routine Vision Exams 
As a reminder, effective October 1, 2013, NHP will no longer require a referral for in-network routine vision exams. Vision services that are non-routine will continue to require a referral.



Optometry Office Visits for Routine Eye ExaminationNo
Optometry Office Visits for Non-Routine Eye ExaminationYes
Ophthalmology Office Visits for Routine Eye ExaminationNo
Ophthalmology Office Visits for Non-Routine Eye ExaminationYes
Eye Exams - Routine
Eye Exams - Non-Routine

We appreciate your feedback and your willingness to collaborate with us to ensure that NHP members receive exceptional service at all times.   


Affordable Care Act Update 
Starting in January 2014, the Affordable Care Act (ACA) will give millions of Americans unprecedented access to affordable health care. Access to care is an integral part of our mission at Neighborhood Health Plan (NHP), and we're working hard to meet all of the new federal requirements.

New Plans for the Merged Market
In 2014, Commonwealth Care will no longer be available to our members, and Commonwealth Choice and Business Choice plans will no longer be available in the merged market (individuals and groups 1-50).

In light of these discontinuations, we are pleased to announce that NHP was recently certified as a Quality Health Plan and awarded the seal of approval to offer new, ACA-compliant plans. We will offer these plans through the MA Health Connector, the direct sales market, and brokers.

New Medicaid Plan
We are also pleased to announce that NHP was named a CarePlus plan by the state Executive Office of Health and Human Services (EOHHS). CarePlus is a new MassHealth plan that will be available to qualified residents starting January 1, 2014. Many of our members in current MassHealth plans and Commonwealth Care will transition to the new CarePlus plan.
Impact on NHP Membership
Members who will be impacted by these changes will be notified via letter ninety days prior to their policy's end date. We'll advise these members to choose another plan prior to their policies end date to avoid a discontinuation in coverage.
  • We expect that half of our current Commonwealth Care membership will qualify for a Medicaid plan, and the other half will quality for a commercial plan.
  • We expect all of our current Commonwealth Choice and merged market Business Choice members to simply transition into another ACA-compliant commercial plan.
  • All members will continue to have access to NHP's extensive network of providers, which includes over 4,100 primary care providers and 13,400 specialists.
  • The Health Connector is responsible for notifying members who have coverage through the Connector.
  • NHP is responsible for notifying impacted members in the merged market.    
Seizures Program 
As previously communicated, effective October 1, 2013, NHP's vendor for disease management forcertain chronic conditions, AccordantCare, will no longer be offering the seizures program.
For all other disease management programs that AccordantCare currently administers, AccordantCare will continue to offer these programs to our members.

Members may seek assistance with their health questions via our Nurse Advice Line at 1-800-462-5499 (open 24 hours a day, 7 days a week), or their care management needs via NHP Member Services at 1-800-462-5449 (Monday through Friday, 8:00 a.m. to 6:00 p.m., and Thursdays 8:00 a.m. to 8:00 p.m.).
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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