Provider News 
NHP Launches PPO Option on July 1
New Commercial Product
As the fastest growing commercial health plan in Massachusetts, NHP is expanding its products and choices for employers. Starting July 1, NHP will offer a PPO option alongside our HMO products to small and large employers across the state.

"We are pleased to expand our comprehensive health care coverage options," said Deborah C. Enos, NHP President and CEO. "NHP is continuing to find new ways to support our members and partners when and where they need it. We remain committed to providing access to high-quality health care that is both affordable and convenient."

MultiPlan's Private Healthcare Systems Network
NHP has partnered with MultiPlan, Inc to provide National coverage for the PPO option. The Private Healthcare Systems (PHCS) PPO network will be available for in-network coverage. NHP providers who are in the PHCS PPO network will be reimbursed at the PHCS contracted rate.

The PPO option allows members the flexibility to seek care outside the PHCS network. Members may see a higher cost-share if they choose to seek out-of-network care. NHP contracted providers who are not in the PHCS PPO network will be reimbursed at their arrangement with MultiPlan or at MultiPlan's out-of-network rate.

To see a listing of PHCS contracted providers or to find instructions on how to join the PHCS network, go to

For additional information on the PPO option, Click Here

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 August 15, 2014.

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


The Signs and Symptoms of Measles   

Provider Education 

Measles (also called Rubeola) is a respiratory disease caused by a virus and can easily spread through the air by breathing, sneezing, or coughing. Serious complications resulting from measles include pneumonia, seizures, diarrhea, ear infections, brain tumors, and miscarriage in pregnant women.

Although widespread use of the measles vaccine has drastically reduced the number of the reported measles cases in the United States over the past decade, this highly contagious disease can quickly spread among unvaccinated people and under-vaccinated communities. In some cases, unvaccinated visitors to the U.S. and unvaccinated U.S. travelers returning from other parts of the world can unknowingly bring back this disease.

Signs and Symptoms
Measles symptoms generally begin about 7-14 days after exposure. The infected individual will experience a mild to moderate fever lasting a few days, followed by a cough, runny nose, sore throat, and red watery eyes. Tiny white spots found inside the mouth (Koplik's spots) may appear.

About 2-4 days after early symptoms appear, a skin rash will develop on the face and upper neck. The rash will spread down the trunk then extend to the upper and lower extremities.

Anyone who has not received the vaccination for measles, mumps, and rubella (MMR) can be infected with this measles. The vaccination includes 2 doses. The first does is typically given to children 12 to 15 months of age. The second dose is typically given after 4 years of age.

Boston Public Health Commission Fact Sheet
Centers for Disease Control and Prevention


Access To Care Survey   



Thank you to all providers who completed the Access to Care Survey! NHP sends out this annual survey to primary care providers and specialists. The information collected helps NHP better understand the member wait time experience at provider offices and supplies us with required reporting information to NCQA.

All completed surveys were entered into a raffle drawing. Congratulations to Angela Mauceri of Lynnfield Pediatrics for winning an iPad Mini.



Revising Authorizations and Submitting Clinical  



Revising Authorizations
It may be necessary at times to update an existing authorization when additional days/units are requested or when there's a change in the service type. Click here to view a step-by-step training guide on how to process authorization revisions.

Uploading Clinical Documentation

Clinical documentation is often required to support the authorization review process. For initial authorizations or revisions to existing authorization, please submit clinical documentation if the case is in a pend status. Insufficient clinical documentation may result in the denial of your request. Click here to view a quick tip reference guide.



Clinical Coverage Criteria



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

Click here to view all Clinical Coverage Criteria. 



Payment Policy Guidelines 



The following Provider Payment Guidelines have been updated and are now available on
  • Vision Services (effective 7/1/14) - NHP does not reimburse separately for refraction, except when performed in relation to post-cataract surgery and keratoconus.   

Click here to view all Provider Payment Guidelines. 



Standardized Provider Information Change Form 



To ensure that NHP has your latest practice information, please remember to notify us of any changes. This includes changes to your billing address, practice name, panel status, or other demographic information.

Earlier this year, NHP and the Mass Collaborative* announced the availability of a Standardized Provider Information Change Form. Providers now have the capability to notify multiple health plans of changes to their practice information by filling out just one form. Please refer to the Standardized Provider Information Change Form for a list of health plans that accept this form.

Click here to access the Standardized Provider Information Change Form.

 *The Mass Health Collaborative is a multi-stakeholder group committed to reducing health care administrative burdens and costs. Members of the Mass Collaborative include the Massachusetts Hospital Association, Massachusetts Medical Society, Blue Cross Blue Shield of Massachusetts, the Massachusetts Association of Health Plan, the Massachusetts Health Data Consortium, MassHealth, Healthcare Administrative Solutions, as well as many local payers and providers.  


Section 1202 Payments 



To accommodate the section 1202 rate increase of eligible billed codes for calendar years 2013 and 2014, NHP is in the process of reimbursing providers with qualifying specialties.
  • Enhanced rates are for eligible codes* submitted by provider with a qualifying specialty
  • Reimbursement for previously submitted claims will be conducted in batches  
  • Reimbursement will be reflected as ACA Section 1202 on your explanation of payments 
  • Once the system has been configured, future claims will process with the enhanced rates


*Eligible codes include:
  • Evaluation and Management codes 99201-99499 (or their successor codes)
  • Vaccine Administration codes 90460, 90461, 90471-90474 (or their successor codes) 


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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