Provider News 
You are invited: NHP Regional Provider Meetings
Provider Outreach

NHP Provider Relations is continuing to host a series of special regional provider meetings to engage our network on updates including: what's new at NHP, process and procedure updates, the latest industry news, and other updates that may impact your practice.

Below are upcoming Regional Provider Meetings that are available for registration.

Northeast Regional Meeting 

May 29, 2014
Time: 9:30-11:00 AM
Location: North Shore Medical Center (Salem Campus)
                  81 Highland Avenue 
                  Room: Davenport 102A
                  Salem, MA 01970
RSVP: Click here to sign-up 

Western MA Regional Meeting

Date: June 6, 2014 
Time: 12:00-1:30 PM
Location: Holyoke Medical Center (Auxiliary Conference Center)
        575 Beech Street 
        Holyoke, MA 01040
RSVP: Click here to sign-up

If you have any questions, email 

Health Savings Account Products Available on June 1 

New Commercial Products 


On June 1, 2014, NHP will offer 5 new Health Savings Account (HSA) products to individuals, small groups, and large groups. An HSA is a medical savings account that allows for federal tax-free contributions at the time of deposit and can be used to pay for qualified medical expenses without federal tax liability or penalty. 


Below are the 5 new HSA product offerings (Note that all services other than preventative are subject to the deductible before NHP starts to pay for covered services):


NHP Prime HMO* (available to individuals and small groups)  

NHP Prime HMO HSA 2000/4000 PY 40/85

NHP Prime HMO HSA 2000/4000 PY 50/75


 *Also available on a calendar-year benefit period


NHP Prime Solutions HMO (available to large groups)

NHP Prime Solutions HMO HSA 1500/3000 PY

NHP Prime Solutions HMO HSA 2000/4000 PY

NHP Prime Solutions HMO HSA 3000/6000 PY  


For more information regarding specific products, click here.  



Access To Care  

Provider Survey


NHP conducts an annual survey with providers to help us better understand member access to care experiences as well as supply required reporting information to NCQA. Over the next few weeks, NHP will be reaching out to primary care and specialty practices to complete this survey. We appreciate your participation and timely responses. If you have any questions, please contact


Pharmacy Updates 



As previously communicated, the following Pharmacy updates will be effective May 15, 2014:


Opioid Analgesics 

Opioid overuse, misuse, and abuse continue to be a public health concern both nationwide and statewide. In an effort to align our clinical pharmacy program with recommendations from the Centers for Medicare and Medicaid Services and with other payers across the state, NHP will implement quantity and dose limits for both long and short-acting opioids. For additional information on the quantity limits, click here to read the network notice.  



Effective May 15, 2014, NHP providers must obtain Xolair through our specialty pharmacy, BriovaRx. BriovaRx is located in New England and will be able to ship Xolair prescriptions more efficiently. Providers who recently prescribed Xolair will be contacted by BriovaRx to discuss the transition process. This change will not affect the prior authorization process for Xolair. For more information, please contact BriovaRx at 800-850-9122. 


NHPNet Reminders 

Provider Portal


Role of the User Admin

The NHPNet user administrator at each organization plays a crucial role in managing the access of all NHPNet users at their site. What's great about the User Admin role is that it gives each organization the ability to control who gets to have access and what specific permissions each user will be granted. This allows providers to protect the information and privacy of their patients. Other responsibilities of the User Admin include:

  • Perform user account maintenance (add new users, modify existing users, and delete users who no longer require access or are no longer active within the organization)
  • Ensure that all users within the organization are aware of and are adhering to the most current version of the User Agreement and the NHPNet Terms of Use
  • Ensure that each user has a unique ID and password
  • Ensure that user login IDs and passwords are kept confidential, are not shared among organization staff and are not disclosed to any other party 
  • Perform a monthly account re-validation of the current user list 
  • Immediately notify NHP of any unauthorized use of a user login ID or password or any breach of security  

For further information or questions about NHPNet, refer to the NHP User Guide by clicking here.   


Summary of Benefits 

We've heard that providers are looking for easier ways to obtain member benefit information. Stay tuned for improved features on NHPNet to allow for quicker access to the summary of benefits.



Third-Party Biller Outreach



Many facilities and provider organizations work with third-party billers to assist with billing and claims inquiries. NHPNet has the capability of displaying real-time claims statuses and is the quickest way to access this information. To increase efficiencies, NHP is currently outreaching to facilities, providers, and third-party billers to promote the use of this capability. For those third-party billers who currently don't have access to NHPNet, the user administrator at the facility/provider site will need to approve access.  


If you would like more information on how to grant NHPNet access to your third-party biller, please contact your Provider Relations Manager directly or e-mail  



Re-Credentialing Process   



The re-credentialing process occurs in a 2 year cycle consistent with the practitioner's birth month and year. You will receive a reminder from the Council for Affordable Quality Healthcare (CAQH) every 120 days asking you to review, update, and attest to the accuracy of your information. Non-responses may lead to your contract being terminated and you will be required to go through the full initial credentialing process. As a result, this may impact your claims payment and be a disruption to patient care.

A practitioner who has been successfully credentialed by NHP, and either leaves the practitioner network voluntarily or has been terminated by NHP for any reason with a break in service greater than 30 calendar days, must go through NHP's initial credentialing process again prior to reinstatement in the network.

If you have any questions regarding the re-credentialing process, contact Provider Enrollment and Credentialing at


ICD-10 Testing



Congress recently approved the delay of ICD-10 implementation to October 1, 2015. NHP will continue to participate in ICD-10 readiness testing through the MA Health Data Consortium. We will also continue to offer EDI compliance testing directly with providers. For additional information, please visit the updated ICD-10 Readiness FAQ by clicking here.


Postpartum Appointment Reminder Calls 

Member Outreach 


NHP is conducting a number of outreach calls throughout 2014 to members who have recently given birth. Members are selected based on specific claims data. These targeted outreach calls are intended to educated and encourage new mothers to seek follow-up care after childbirth. With greater awareness, the goal of this initiative is to improve the timeliness of care new mothers receive.

Other member outreach initiatives this year include:
  • Obtaining prenatal care in 1st trimester
  • New member welcome calls
  • Heart health, screenings, and controls
  • Diabetes, screenings, and associated eye health and control levels
  • Medication adherence  

As a result of outreach calls, members may be contacting your office for additional follow-up care or medical advice.   


Clinical Coverage Criteria



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

Click here to view all Clinical Coverage Criteria. 



How Do You Successfully Treat Patients With Asthma?

Asthma Awareness Month 


NAEPP recommends six best practices to be part of every asthma patient office visit

The following six key priority messages have been determined by the National Asthma Education and Prevention Program (NAEPP), and the National Heart, Lung, and Blood Institute of the National Institutes of Health to:
  • Increase a patient's knowledge and skills
  • Improve the process and outcome of asthma treatment
  • Reduce asthma disparities  

#1 - Use inhaled corticosteroids to control asthma   

Inhaled corticosteroids are the most effective medications for the long-term control of asthma. These medications should be taken on a long-term basis to achieve and maintain control of persistent asthma.



#2 - Create an Asthma Action Plan to guide patient care
The panel recommends that all asthma patients receive a written asthma action plan that includes instructions for: (1) daily treatment (including medications and environmental controls), and (2) how to recognize and handle worsening asthma. To see a sample, go to Under the "Clinical Resources" tab, click on "Practice Guidelines", then find the link to Massachusetts Asthma Action Plan.

#3 - Assess current severity and future risk
There is a strong association between a patient's history of exacerbations and the risk for future exacerbations. So it's critical to assess a patient's asthma severity at the initial visit using the domains of current impairment and future risk to determine the type and level of therapy needed. This diagnosis will help classify the patient's asthma severity and predict future risks.

#4 - Assess and monitor asthma control: Adjust treatment if needed
All patients with asthma should be taught to recognize symptom patterns and/or Peak Expiratory Flow measures that indicate inadequate asthma control and the need for additional therapy. Control should be routinely monitored to assess whether the goals of therapy are being met-that is, whether the patient's impairment or risk are being reduced.

#5 - Schedule follow-up visits
Follow-up visits allow clinicians to assess and monitor asthma control and adjust treatment if needed. A stepwise approach to therapy is recommended: the dose and number of medications (and frequency of administration) should be increased when necessary, and decreased, when possible.

#6 - Control environmental exposures
Patients who have asthma at any level of severity should be queried about their exposure to inhalant allergens, particularly indoor inhalant allergens, tobacco smoke, and other irritants, and be advised as to their potential effect on the patient's asthma. Asthma clinicians should review each patient's exposure to allergens and irritants and develop a multi-pronged strategy to reduce exposure with their patient.

To learn more about the report, go to

For additional practice guidelines on, click here


Hospital Updates     



Quarterly Hospital Admissions Report
The latest quarterly hospital 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 Provider Relations at for assistance.

Provider Manual Update

The Performance Reporting and Improvement section (section 5-9) in the NHP Provider Manual has been updated. The update includes clarification to NHP's use of Provider Profiling Systems to support quality improvement activities. To access the provider manual on, click here.

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.

Helen Connaughton
Director of Provider Relations  
Neighborhood Health Plan 

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