Neighborhood Health Plan
Neighborhood Health Plan Provider News
In This Issue
Affordable Care Act Update
NHPNet Functionality
Clinical Support for Asthma and COPD Intervention
Maximum Allowable Units
Technology Updates
Welcome Saint Vincent Hospital
Reminder: Update Your Panel Status
New Specialty Review Vendor
Healthwise® Care Support
My NHP Profile

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The latest Quarterly Hospital Admissions Report is now available for hospitals to access. To view this report, click on the Reports tab in NHPNet, and select Clinical Reports.  
November 2013
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Please find below a list of important Neighborhood Health Plan updates.
Affordable Care Act Update 
Starting in January 2014, NHP will offer new ACA-compliant products for individuals and small groups, as well as MassHealth's CarePlus product.

New Merged Market Commercial Products  

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 products. We will offer these products through the MA Health Connector, the direct sales market, and brokers. NHP Prime is our new ACA-compliant commercial product.   
Click Here to view the new commercial membership cards

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. NHP Connect is our comprehensive plan for new and existing MassHealth members.

Click Here to view the new MassHealth membership card 
NHPNet Functionality
Check Claims Status
As a reminder, NHPNet is your primary point of contact when you need to check claims status with NHP. NHPNet gives you quick and easy access to the information you need, when you need it.

To provide better service levels, we ask that claims calls to Provider Services be limited to only complex claims issues that cannot be resolved on NHPNet.

To initiate a claims status check, go to NHPNet and follow these instructions:
  1. If you have the claim number, enter the number directly from the home page
  2. Click Go
  3. For additional search options (by member ID, all claims for your site), click View additional search options  

Please Click Here to access a step-by-step training tool for claims status checks. 
Clinical Support for Asthma and COPD Intervention
This month, NHP is sending letters alerting providers that certain patients may benefit from asthma or COPD interventions. The mailings will support you in your efforts to provide the very best ongoing care for patients with chronic conditions. They contain the latest information about treatment guidelines along with patient-specific information to help you personalize treatment.  Check your mail or call 855-444-4647 for more information.
Maximum Allowable Units  
In followup to a provider network notice that is being sent out this week:

Effective January 1, 2014, NHP will be implementing maximum unit pre-payment edits for covered services, for all lines of business. The unit maximums will be based on the Centers for Medicare and Medicaid Services Medically Unlikely Edit program, the American Medical Association, and the Correct Coding Initiative.

For more information, click here to view the new Provider Payment Guideline. 
Technology Updates 
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.  
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.

Look out for a network mailing with additional information on both new capabilities. 
Welcome Saint Vincent Hospital
NHP recently announced the addition of Saint Vincent Hospital in Worcester to its provider network.

Under the new partnership, NHP members can now access services at this award-winning community hospital that has provided high-quality health care to the region for more than 120 years. Saint Vincent Hospital has been named one of the nation's 100 Top Hospitals for three years in a row by Truven Health Analytics, and one of the Top 50 Hospitals for heart care by Reuters earlier this year.

With NHP, members get access to a large network of doctors and top hospitals and community health centers, effortless customer service and great wellness benefits - at a price they can afford. All plans are offered through NHP's broad commercial network that gives members access to 69 hospitals, more than 4,300 primary care providers and over 13,000 specialists in 11 counties across Massachusetts. NHP's service area includes: Barnstable, Bristol, Dukes, Essex, Hampden, Middlesex, Nantucket, Norfolk, Plymouth, Suffolk, and Worcester. 
Reminder: Update Your Panel Status 
Inaccurate information that is displayed on our Provider Directory often times leads to member confusion when trying to select a panel. As a reminder for Primary Care Providers, please remember to notify NHP of any changes to your panel status so the correct information is accurately displayed. 


To update your information, send an email to Provider Enrollment at
Click Here to access the Provider Directory.  
New Specialty Review Vendor 
In a recent network notification, NHP announced that beginning on November 10, 2013, we will partner with Medical Review Institute of America (MRIoA), an independent review organization, to supplement our specialty reviews of prior authorization requests.

MRIoA's network of board-certified, practicing physicians provides external review resources in a wide variety of specialties. MRIoA will provide support only in rare instances when NHP physician reviewers are unavailable. This partnership will help us ensure a timely response to your prior authorization requests.

Please continue to follow the existing NHP prior authorization process. If MRIoA is reviewing your request, their representatives will contact you directly.
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 Influenza. 
Influenza (Seasonal Flu)
Last Revised: January 15, 2013
Author: Healthwise Staff
What is influenza (flu)?
Influenza (flu) is a viral infection. People often use the term "flu" to describe any kind of mild illness, such as a cold or a stomach virus, that has symptoms like the flu. But the real flu is different. Flu symptoms are usually worse than a cold and last longer. The flu usually does not cause vomiting or diarrhea in adults.

Most flu outbreaks happen in late fall and winter.

What causes the flu?
The flu is caused by influenza viruses A and B. There are different strains of the flu virus every year.

What are the symptoms?
The flu causes a fever, body aches, a headache, a dry cough, and a sore or dry throat. You will probably feel tired and less hungry than usual. The symptoms usually are the worst for the first 3 or 4 days. But it can take 1 to 2 weeks to get completely better.
It usually takes 1 to 4 days to get symptoms of the flu after you have been around someone who has the virus.
Most people get better without problems. But sometimes the flu can lead to a bacterial infection, such as an ear infection, a sinus infection, or bronchitis. In rare cases, the flu may cause a more serious problem, such as pneumonia.
Certain people are at higher risk of problems from the flu. They include young children, pregnant women, older adults, and people with long-term illnesses or with impaired immune systems that make it hard to fight infection.
How is the flu diagnosed?
Your doctor will ask you about your symptoms and examine you. This usually gives the doctor enough information to find out if you have the flu, especially if many cases of a similar illness have occurred in the area and the local health department reports a flu outbreak.
In some cases, the doctor may do a blood test or take a sample of fluid from your nose or throat to find out what type of flu virus you have.
How is it treated?
Most people can treat flu symptoms at home. Home treatment includes resting, drinking plenty of fluids, and taking medicine to lower your fever.
If you think you have the flu, your doctor may be able to give you medicine that can make the symptoms milder. But you need to start taking it within 2 days of your first symptoms.
Can the flu be prevented?
You can help prevent the flu by getting the flu vaccine every year. It's best to get the vaccine as soon as it's available. You can get the vaccine as a shot or in a spray that you breathe in through your nose.
The U.S. Centers for Disease Control and Prevention recommends that everyone 6 months old and older should get a flu vaccine. The vaccine is especially important for people who are at higher risk of problems from the flu, including:
  • Young children.
  • Adults ages 50 and older.
  • Adults and children who have long-term health problems or an impaired immune system.
  • Women who will be pregnant during the flu season.

The flu vaccine is also important for health care workers and anyone who lives or works with a person who is at higher risk of problems from the flu.


The vaccine usually prevents most cases of the flu. But even if you do get the flu after you've had the vaccine, your symptoms will be milder and you'll have less chance of problems from the flu. You cannot get the flu from the flu vaccine.

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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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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