Provider News 
Primary Care Provider Behavioral Health Screening Requirement 
Standardized behavioral health screening tools are effective in identifying children with behavioral health problems. NHP will reimburse PCPs who offer standardized and age-appropriate screening tools at all well-child visits for Commercial and MassHealth members under the age of 21 (up to 1 unit per patient per day). Reimbursement for the screening tool is in addition to the reimbursement for the well-child visit.

In some instances, PCPs who appropriately offer screening tools to their patients do not correctly submit claims with the correct service code or modifier. A practice that incorrectly submits claims on 5,000 pediatric members in a year could potentially increase their reimbursement by $50,000 if those claims were submitted with the correct service code and modifier.

How to submit claims
Use service code 96110 (Developmental testing: limited) with the appropriate "U" modifier:


Click Here to learn about the requirement and reimbursement information. 

ICD-10 Readiness



NHP is currently accepting requests for EDI 837 transaction compliance testing. End-to-end testing will be comprised of adjudicating claims and returning 835 remittance advice transactions. If you would like participate in EDI compliance testing, email Vincent Chiachio at

An updated ICD-10 Readiness FAQ is now available for your reference. The updates include the following claims related question:

How Is NHP claims processing affected by ICD-10?
Inpatient Claims
NHP does not pay by DRG. Inpatient claims are paid at a per diem rate, a percent of charge rate, SPAD, or a case rate. There is no ICD-CM or ICD-PCS impact on inpatient claim processing.
Diagnosis to Procedure Code Checks
NHP does not currently run any Diagnosis to Procedure checks in claims processing. Currently and for the foreseeable future, this is only done on retrospective audit. There is no claims adjudication process affected.
Authorization/Claims Matching
NHP does not use ICD-CM or ICD-PCS in authorization matching to claims.
Covered Benefits
The following is the full range of benefits having a dependency on ICD-CM codes. No benefits have a dependency on ICD-PCS codes.
  • Abortion
  • Acupuncture
  • Behavioral health redirect
  • Breast pumps
  • Cleft lip and palate related services  
  • Dental services
  • Diabetic supplies  
  • Early intervention  
  • Family planning  
  • Infertility
  • OB/GYN
  • Podiatry
  • Preventative screening/counseling/visits
  • Smoking cessation
  • Vision services routine/non-routine
  • Weight management 

To access the full ICD-10 FAQ on, Click Here.


Educating Our Members  



We've heard from providers that MCOs can better support providers by educating members on their plan and benefit coverage. Here are some updates on how NHP is educating our members:

Enhanced Member Portal
Our enhanced member portal, MyNHP, makes it easy for members to access their plan and benefit information at any time. This includes the ability to view their plan information, benefits, co-pays, and deductibles, which can be helpful to understand when planning for upcoming services. If your NHP patient would like to register for MyNHP, please direct them to

Outreach Calls
To increase member engagement, NHP will be outreaching to our members through targeted calls such as welcoming new members and encouraging our members to seek certain health care services. Over the next few months, NHP is planning to conduct the following awareness calls: prenatal/postpartum care, heart health, diabetes, and medication adherence. For questions related to one of these topics or other patient care topics, members should consult with their provider.

Community Outreach
Over the past few months, the industry has seen many changes including a higher volume of membership transitions. To engage our members (and prospective members), our Community Outreach team has been working hard with provider groups and community organizations to increase awareness of the changes and of available programs/resources.

Member Welcome Kits
NHP engages all new members by sending a welcome kit that includes information on available resources and programs. Included in the packets are information on how to access the Provider Directory and Member Handbook, specific plan benefits, pharmacy programs, and a breakdown on how cost-sharing works.

Click Here to access the full member cost share brochure


Adult BMI Assessment



Measure Description

Patients 18-74 who had their body mass index (BMI) and weight documented during an outpatient visit, either by a claim or as a medical record entry during the measurement year or the year prior.


How To Improve This Measure

To improve your HEDIS score for the Adult BMI Assessment, use the appropriate diagnosis codes for BMI and BMI percentile. To support NCQA requirements, NHP conducts regular chart reviews for HEDIS measures. For each office visit claim that is submitted with the appropriate BMI code, a chart review will not be requested for this measure. 


Adult BMI Codes




Clinical Coverage Criteria 



The following Clinical Coverage Criteria have been updated and are now available:


Click Here to view all Clinical Coverage Criteria. 



1500 Paper Claims Form 



As previously communicated, effective 4/1/14, providers should be using the updated 1500 paper claims form (version 02/12) that the National Uniform Claim Committee (NUCC) approved for paper claims submissions. Please discontinue use of old forms.
Click Here to view the revised form. 


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. 

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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