Neighborhood Health Plan
Neighborhood Health Plan Provider News
In This Issue
Learn How The Affordable Care Act Impacts Your Practice and Patients
Affordable Care Act Update
Technology Updates
NHPNet Functionality
Claims Update
1500 Paper Claims Form
Clinical Support for Asthma Management
Clinical Support for Diabetes Management
Lifting Authorization Requirement for Codes 67314 and 67318
Behavioral Health Screening
2013 Provider Study Results
Update Provider Manual
My NHP Profile

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December 2013
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Please find below a list of important Neighborhood Health Plan updates.
Sign-Up Today: Learn How The Affordable Care Act Impacts Your Practice Operations and Patients
NHP Provider Relations is hosting a series of special regional meetings to engage our network on the Affordable Care Act.

Over the past few months, we held sessions on the Cape and in the Northeast, as well as large and small forums at provider locations. With feedback from our providers that the information we are sharing is timely, valuable, and supportive to their practice operations and our members who may be experiencing coverage change, we will continue to engage our network in other areas.

With additional seats available at our upcoming Southeast and Greater Boston regional meetings, sign up today to reserve a spot (click on the RSVP link below). Lunch will be served.

Southeast Region:


Date:         Tuesday December 3, 2013

Time:        11:30-2pm

Location: Holiday Inn Taunton

                   700 Myles Standish Blvd 

                   Taunton, MA 02780

RSVP:      Click here to sign up  

Greater Boston:


Date:         Thursday December 5, 2013

Time:        11:30-2pm

Location: The Lantana 

                   43 Scanlon Drive  

                   Randolph, MA 02368

RSVP:      Click here to sign up

Please email if you have any questions.
Affordable Care Act Update 
On November 11, 2013, the Obama Administration gave states permission to decide if they will allow a 1-year extension of health insurance plans for individuals that were scheduled to be cancelled under the Affordable Care Act (ACA).

On November 18, the Massachusetts Commissioner of Insurance Joseph Murphy announced that Massachusetts will not extend non-compliant plans for 1-year. In a letter to the Department of Health and Human Services, Murphy indicated that almost all health insurance products in MA already meet the minimum coverage requirement after six years of requiring basic minimum benefit levels. A "delay in certain market reforms, could cause confusion and significant market disruptions."

NHP supports the State's decision to bring additional benefits of the ACA to the residents of the Commonwealth in 2014 and continue the success we've already achieved in Massachusetts. Under the ACA, individuals will have the unprecedented access to enhanced, low cost health plans. Through the Health Connector, some may qualify for new State and Federal subsidies/tax credits.

Commonwealth Care Update
In another recent announcement, the state announced that Commonwealth Care members will now have until 3/31/14 to re-enroll for coverage. This will align all commercial members with the federal open enrollment period.

Members who re-enroll today can take advantage of enhanced benefits and lower costs as early as 1/1/14. NHP will continue to cover benefits for eligible members under the Commonwealth Care line of business until 3/31/14.
Technology Updates 
As previously communicated, NHP will be offering our providers Electronic Funds Transfer and Electronic Remittance Advice capabilities as of January 1, 2014.

Click Here to see the network notification
NHPNet Functionality
Member Benefit Verification
As a reminder, NHPNet is your primary resource to obtain your NHP patient's detailed benefit information.

To view a step-by-step reference guide on how to check your patient's benefits on NHPNet, Click Here.  
Claims Update
Network notification letters have been sent out regarding the following topics. Click on the links below for more information: 
  • Early Intervention - Beginning with claims received on or after January 1, 2014, NHP claims processing for early intervention will now measure code T1024 in 15 minute increments (1 unit = 15 minutes) 
  • Professional Evaluation and Management Services / Modifiers - Beginning with claims received on or after February 1, 2014, NHP will follow the the National Correct Coding Initiative edits.
1500 Paper Claims Form 
Please remember that NHP strongly encourages the use of electronic claims submissions.

For paper claims submissions, NHP will start accepting an updated 1500 paper claims form beginning 1/6/14 that the National Uniform Claim Committee (NUCC) recently approved. Providers may submit either the current or the revised 1500 form until 3/31/14.

Effective 4/1/14, NHP will only accept the revised form for all paper claims submissions.

Click Here to view the revised form.
Clinical Support for Asthma Management
NHP will resume our 2014 asthma-intervention mailings for providers this month. As part of this program, twice a month we'll send PCPs and pulmonary specialists a patient report.  The report identifies patients who demonstrated at least three prescriptions for symptom-relieving asthma medications (quick acting beta-agonist and/or oral steroid) in the past four months.

You can access this report and other patient data on NHPNet.

To support your patients with asthma this winter, NHP will waive copays for all asthma controller medications until December 31. We've already sent letters to members who can benefit from this special offer.

If you would like to refer a patient to our Asthma Care Management program, please call 855-444-4647 and ask to speak with an Asthma Care Manager.

Clinical Support for Diabetes Management
NHP is offering support to help you manage care for patients with diabetes.

In December, we'll be sending PCPs a report identifying any patients who have missed one or more of their four ADA-recommended tests and exams: the A1C test, LDL cholesterol test, microalbumin test, and dilated eye exam. NHP has already sent these patients a Diabetes Missed Screens letter. The letter encourages patients to schedule their necessary tests as soon as possible. It also suggests that they talk to you about their target numbers for each of these tests and whether additional testing is right for them. This Diabetes Missed Screens letter is in addition to the annual screening reminder that NHP sends to all members with diabetes.

You can access this report and other patient data on NHPNet.

We're mailing patients with diabetes a copy of our 2014 Live Well with Diabetes calendar. The calendar encourages members to stay on track throughout the year by providing information and resources in five areas of diabetes management:
  • Getting screened
  • Staying active
  • Eating healthy
  • Taking their medicine
  • Quitting smoking 
The calendar also includes a wallet card to help members track their recommended diabetes screenings.  We encourage you to ask your patients to bring this card to their appointments.

If you would like to refer a patient to our Diabetes Care Management program, please call 855-444-4647 and ask to speak with a Diabetes Care Manager.

Lifting Authorization Requirement for Codes 67314 and 67318
Effective immediately, revision of eye muscle codes 67314 and 67318 no longer requires authorizations. Please always remember to verify the member's eligibility and benefits prior to providing any service.
Behavioral Health Screening
Neighborhood Health Plan (NHP) requires that Primary Care Providers (PCPs) offer periodic and medically necessary inter-periodic screens to members under the age of 21 in accordance with the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) and Preventive Pediatric Healthcare Screening and Diagnosis (PPHSD) Periodicity Schedules. This requirement applies to MassHealth members only. However, to minimize administrative complexities and in our continuous quality improvement efforts, NHP covers this service for all members.

NHP reimburses one (1) screening per member per day, regardless of the number of screening tools administered for a member on a single day.

Additionally, procedure code 96110 must be billed with the appropriate U modifiers (U1 - U8) indicating the type of provider who conducted the screening and whether a behavioral health need was identified. To be eligible for reimbursement, Primary Care Providers (MDs and NPs) must use specific, clinically appropriate behavioral health screening tools accommodating different age ranges while allowing some flexibility for provider preference and clinical judgment.

Claims submitted without the corresponding U modifier are subject to deny.

Please share this important change with billing and other staff as you deem appropriate. Additional information on this requirement is available within the Billing section of our Provider Manual.   
Click Here for more information on the MassHealth webpage
2013 Provider Study Results
One of the ways NHP measures network satisfaction is by using an external survey company to gather provider feedback. In June and July 2013, over 400 telephone surveys were conducted with office managers and physicians. The survey asks providers about their thoughts about operations, care management, utilization management, timeliness of decision-making, and ease of processes. The 2013 findings are as follows.  

Highest levels of satisfaction
  • Enhanced website
  • Ease of access to eligibility information
  • Timely claims payment
  • Enhanced responsiveness in processing pharmacy authorizations

With your feedback, we have identified areas of potential focus including the authorization submission process and providing quicker access to an NHP representative.


Thanks to all study participants for their input. We look forward to continuing to improve the services we provide to our network. Stay tuned for updates in 2014.

Provider Manual Updated   
In December, an updated 2014 NHP Provider Manual will be posted for your reference. When available, please visit to view all the updates.  
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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