February 2014
Provider News 
Affordable Care Act Updates    
Affordable Care Act
Provider Services Line

doctor.jpg As the entire industry is working to meet the new Affordable Care Act requirements, we understand that this can be a confusing time for you and your patients. We recognize that providers are experiencing longer wait times when calling our Provider Services team, and we appreciate your patience. With many providers calling in to confirm member eligibility and verify member PCPs, please remember that this information should be obtained through our secure provider portal, NHPNet. In order for our Provider Service team to better support you through more complex issues, you should always refer to NHPNet for simple transactions and status inquiries.

Not Registered for NHPNet? Click Here to sign-up.

Transition of CeltiCare CarePlus members to NHP

On January 1, 2014, a MassHealth system error incorrectly auto-assigned some CarePlus members to CeltiCare. Impacted members may have received CeltiCare ID cards and been auto-assigned to a new PCP. Upon discovery, a system fix was implemented and impacted members were notified of the error. Impacted members will correctly be reassigned to NHP with an effective date of February 1, 2014.

For all members, please remember to always refer to NHPNet to access the latest eligibility information. Members who show active eligibility in NHPNet, but have yet to receive their NHP ID card can access a temporary ID card by going to NHP.org/member and selecting "Print Temporary ID Card."

For questions related to transition of care, please refer to the Transition of Care FAQ by Clicking Here.

Important Upcoming Dates
  • March 24 - Commonwealth Care members must re-enroll in a new plan and pay their first premium by this date for coverage that starts on April 1
  • March 31 - Federal open enrollment period ends
  • April 1 - New ACA-compliant plan effective date for existing Commonwealth Care members (if they re-enrolled by 3/24/14) 

Explanation of Payment Suppression, Electronic Funds Transfer, Electronic Remittance Advice



To support the Affordable Care Act requirements, and eliminate the unnecessary use of paper, NHP is now offering our providers new electronic capabilities. Start your registration today for these new services:
  • Explanation of Payment (EOP) Suppression: Providers can request to stop receiving paper EOPs in the mail. EOPs can still be viewed and printed any time on NHPNet. 

  • Electronic Funds Transfer (EFT): NHP has partnered with Alegeus Technologies to simplify EFT registration and payment. Receiving payments via EFT is a free service in which NHP delivers payments directly to your organization's bank account - rather than via paper check.   
  • Electronic Remittance Advice (ERA): On February 1, 2014, providers who were receiving ERAs in 2013 will no longer receive their paper EOPs in the mail. Providers who register to receive ERAs in 2014 will stop receiving paper EOPs within 31 days. All providers and designated staff members can view their EOPs at any time on NHPNet.   
To register for any of these services, go to NHPNet and click on the enrollment link found in the E-Business Tab. If you have any questions during EFT registration, please contact Alegeus at 877-389-1160 or ProviderNet@Alegeus.com. For questions related to ERA registration or EOP suppression, please contact the NHP Provider Service Team at 855-444-4647.


Discontinuance of Internet Explorer 7 Browser Support

Technology Update  


Beginning on April 1, 2014, HealthTrio, LCC will discontinue support of Microsoft's Internet Explorer 7 browser. Providers use HealthTrio to enter authorizations and referrals. For the best compatibility and provider experience, please use a later version of Internet Explorer or another web browser. 


1099 Tax Form 



Provider 1099 tax forms were sent out on January 31st. Please allow up to 10 business days to receive your copy. If you have not received your 1099 in the mail after 10 business days or if you have additional questions, send an email to: providerservice@nhp.org

1500 Paper Claims Form 



As previously communicated, NHP now accepts the updated 1500 paper claims form that the National Uniform Claim Committee (NUCC) approved. Although NHP strongly encourages the use of electronic claims submissions, we will accept either the current or revised 1500 form until 3/31/14 for any paper submissions.

Effective 4/1/14, NHP will only accept the revised 1500 form for all paper claims submissions.

Click Here to view the revised form. 


Authorization Requirement For Out-Of-Network Services 



As a reminder, all requests for out-of-network providers or services require an authorization. This includes services that do not have a prior authorization requirement when a contracted provider renders the service. Claims will reject for out-of-network services unless an approved authorization has been obtained.


Provider Payment Guidelines 



The following Provider Payment Guidelines have been updated and are now available:
Click Here to view all Provider Payment Guidelines


Quarterly Hospital Admissions Report  



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. If you do not have access to NHPNet, you may contact prweb@nhp.org for assistance.


Diabetes HbA1c  

HEDIS Measurement


Why This Is Important

Diabetes is one of the most costly and highly prevalent chronic diseases in the United States. Approximately 20 million Americans have diabetes and half these cases are undiagnosed. Complications from the disease cost nearly $100 billion annually. Comprehensive diabetes management can prevent health complications and improve the quality of life for millions of Americans. Studies have shown the following benefits of properly managing diabetes: reducing A1c blood test results by 1 percentage point (e.g., from 8.0% to 7.0%) reduces the risk of microvascular complications (eye, kidney and nerve diseases) by as much as 40%; blood pressure control reduces the risk of cardiovascular disease by as much as 50% and the risk of microvascular complications by 33%; and improved low-density lipoprotein cholesterol (LDL-C) control can reduce cardiovascular complications by as much as 50%. 
How To Improve Patient Care
  • Review and perform diabetes related care at each office visit, and promote regular follow-up to monitor adherence and barriers to self-management
  • Order labs prior to patient appointments
  • If point-of-care HbA1c tests are completed in-office, bill for this and ensure HbA1c results and date are documented in the patient's chart
  • Adjust therapy to improve HbA1c levels; follow-up with patients to monitor changes 
  • Evaluate and treat other cardiovascular disease risk factors such as smoking, hypercholesterolemia and hypertension
  • For patients on stable regimens, take advantage of NHP's 90 day supply of medications to increase compliance and reduce cost


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