Provider News 
You are invited: Western MA Regional Provider Meeting
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.

The next regional meeting available for registration will be on June 6th:  

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 

Explanation of Payment Suppression    



NHP offers providers the ability to access downloadable explanation of payments (EOPs) via NHPNet, the secure provider portal. In addition to being a positive environmental impact, paperless options allow for greater protection of member privacy information. With on-demand access to view or print current and historical EOPs, NHP will no longer mail paper EOPs to providers starting later this year.

If you would like to suppress your paper EOPs today, please log on to NHPNet and click on the EOP Suppression link found at the bottom of the Explanation of Payment box (see below image).

To request user access to your site's NHPNet account, please contact your site's User Administrator. If your site is not yet set up for NHPNet, please click here to start the registration process.

For all questions regarding NHPNet, please send and e-mail to your Provider Relations Manager at


Provider and Hospital Satisfaction Surveys   



NHP conducts annual surveys with providers and hospitals to help us better understand the satisfaction level of our network. Survey results will be used to help us evaluate our strengths and identify opportunities. Over the next few months, you may be contacted to participate in a telephonic survey. We appreciate your participation and feedback. If you have any questions, please contact


How to Add Provider Sites To Your Existing NHPNet Account  

NHPNet Tips 


Step 1: Select "Your Profile" within the Resources drop-down list



Step 2: Click on "Site Access" on the left side menu



Step 3: Click "Request Site Access" 



Step 4: The Request Site Access window will appear. Complete the required fields and click Submit.    


To view the full NHPNet User Guide, click here.   



Health Savings Account (HSA) 

Commercial Product Update  


HSA-compliant plans available on June 1  
As previously announced, NHP will offer 5 HSA-compliant plans to individuals, small groups, and large groups:


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.  



Pharmacy Updates 



Over-the-Counter (OTC) Drug Benefit

Effective June 9, 2014, the following products will be added to the OTC list for all NHP members:

  • Pyridoxine (vitamin B6)
  • Nasacort Allergy 24 Hour  

Nasal Steroid Step Therapy

NHP's Step Therapy Programs encourages members to try a select 1st line medications before alternative (2nd line) medications are prescribed. Effective June 9, 2014, the following changes will be implemented to the Nasal Steroid Step Therapy program:   


1st Line Medications  

2nd Line Medications
Flunisolide (compare to Nasalide 25mcg)

Flunisolide (compare to Nasarel 29mcg)

Fluticasone propionate (compare to Flonase)

Nasacort Allergy 24hr (triamcinolone)


Triamcinolone Acetonide (Nasacort AQ)

Beconase AQ (beclomethasone)

Nasonex (mometasone)

Omnaris (ciclesonide)

Qnasl (beclomethasone HFA)

Rhinocort Aqua (budesonide)

Veramyst (fluticasone furoate)

Zetonna (ciclesonide)


New Pharmacy for Makena
Effective July 1, 2014, Johnson Compounding and Wellness in Waltham will be able to dispense Makena for members who meet prior authorization criteria. Members who are using an alternative pharmacy besides Johnson Compounding will be grandfathered and can continue to use the same pharmacy. 


1500 Paper Claims Form (version 02/12) 



As a reminder, the CMS-1500 paper claims form has been revised and approved by the National Uniform Claim Committee (NUCC). The revised form, version 02/12, has replaced version 08/05.

NHP recommends the electronic submission of all claims. For paper claims submissions, NHP will only accept the revised CMS-1500 form (version 02/12). Paper claims submissions on an older version of the 1500 form will not be processed and will be returned to you.

You can access the latest 1500 form on the NUCC website at



Antidepressant Medication Management (AMM) Member Outreach Program     


Providers now have the opportunity to refer their NHP patients into an Antidepressant Medication Management program administered by Beacon Health Strategies. This new member outreach program is designed to improve medication adherence of members who are prescribed antidepressants. Trained health coaches provide telephonic member outreach to enrolled members. NHP Members may benefit from participation by having a successful outcome associated with improved adherence for their newly prescribed antidepressant medication therapy.

Eligible members must:
  • Be an NHP member and at least 18 years of age
  • Be starting a new course of prescription antidepressant treatment and thus have NOT filled a prescription for an antidepressant medication in the immediately preceding 90 days from when the new prescription was filled 
  • Have been recently (within last 30 days) prescribed an antidepressant which was filled at a pharmacy  
Benefits of Referral Program:

1.    Provides direct patient / provider contact to discuss the program leading to improved enrollment when compared to automated calls
2.    Improves member's understanding of program's purpose and value
3.    Provider receives monthly reporting on patient status in program

Questions about this program or requests for referral/enrollment forms may be directed to 781-994-7572 or by email at


Clinical Coverage Criteria



The following Clinical Coverage Criteria have been updated and are now available on
  • Infertility Services (effective 7/1/14) - update to criteria including but not limited to: reversal of sterilization, IUI cycle limit, cryopreservation, MESA, TESE 

Click here to view all Clinical Coverage Criteria. 


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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