August 2014
Provider News 
Paper Explanation of Payment Suppression on 8/15/14
NHP offers providers the ability to access downloadable explanation of payments (EOPs) via NHPNet, the secure provider portal. In addition to having 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.

Please ensure that the appropriate staff at your office have access to NHPNet. If you have any questions regarding access to NHPNet, please email

Standardized Behavioral Health Screening Tools  for PCPs 


Standardized behavioral health screening tools are effective in identifying children with behavioral health needs. NHP will reimburse PCPs who offer standardized and age-appropriate screening tools at each well-child visit for Commercial and MassHealth members under the age of 21 (up to 1 unit per patient per day).

On July 1, 2014, MassHealth revised the list of approved standardized screening tools. Changes include:
  • The addition of the Early Childhood Screening Assessment (ECSA)
  • The addition of the Modified Checklist for Autism in Toddlers, Revised, with Follow-up (M-CHAT-R/F)
  • The addition of the Survey of Well-being of Young Children (SWYC)
  • The use of the Patient Health Questionnaire-9 (PHQ-9) for members aged 13 and older 
Click Here to see a full list of approved screening tools.


Pharmacy Updates 



Proton Pump Inhibitors

The following changes to the Proton Pump Inhibitor (PPI) program are effective October 1, 2014:

Nexium will be replaced by Over-the-Counter (OTC) Nexium 24HR 

Prescription Nexium will be removed from the pharmacy benefit and will no longer be covered. NHP will cover OTC Nexium 24HR 20mg, which has the same active ingredient, esomeprazole. Omeprazole will remain the first line agent in NHP's PPI step therapy program. OTC Nexium 24HR will be covered as a second line agent and will only be covered if a patient has tried and failed generic omeprazole.


Lansoprazole 15mg capsules will replace lansoprazole 30mg
Prescription lansoprazole 30mg will be removed from the pharmacy benefit and wi
ll no longer be covered. NHP will cover lansoprazole 15mg capsules as a second line agent. Omeprazole will remain the first line agent in NHP's PPI step therapy program. Lansoprazole 15mg capsules will only be covered if a patient has tried and failed generic omeprazole.

Click Here for additional information on the changes to the PPI program.


NHP uses BriovaRx as our specialty vendor for Synagis. We will be covering the cost of the injection as well as the administration of Synagis throughout the respiratory syncytial virus (RSV) infection season (November through March) only if obtained from BriovaRx. Synagis and all supplies necessary for the administration will be shipped out and delivered to your office within 24 to 48 hours after ordering. NHP can be billed for administration of the drug.

Click Here to view Synagis authorization and criteria information.



NHPNet Updates



User Renewals
NHPNet, the secure provider portal, now requires that users renew their accounts every 365 days. The change from 180 days allows for additional time for user administers to verify that all NHPNet users at their site have the appropriate access. A reminder will be sent out to users 30 days prior to their renewal deadline. Accounts that are not renewed by the deadline will no longer have access to certain features of NHPNet.


Eligibility View

When checking member eligibility, NHPNet will now default to the current eligibility segment of the member you select. Previously, providers were required to select the current eligibility segment from a drop-down list.


If you have any questions about accessing NHPNet or would like to request a training, please contact



Home Infusion Therapy Claims Submission       

Quick Tips 


Home infusion therapy requests often require providers to submit multiple authorization and claims correspondence. To assist you with the claims submission process so that your home infusion claims are processed appropriately, a reference guide is now available.

Click Here to view the reference guide.   

Castlight Health    



NHP and Castlight Health have partnered to offer commercial members with a real-time cost estimator tool. Beginning July 15, 2014, NHP members enrolled in an HMO commercial plan can access Castlight's online tool via the member portal. The cost estimator tool allows members to see a breakdown of how much they should expect to pay for a requested service.

Here's a look at the cost estimator tool:




The cost estimator tool will not offer estimates for certain services, including but not limited to: durable medical equipment, vision care, retail pharmacy, orthotics, prostheses, and behavioral health services. For estimates that cannot be provided through Castlight's cost estimate tool, members can request an estimate by completing the online cost estimate request form located in the member portal.



Clinical Coverage Criteria   



The following Clinical Coverage Criteria have been updated and are now available on
  • Home Health Care (effective 8/1/14) - separated homebound from home setting (added definitions and relevant footnote), added goals to physician plan of care, and added exclusion #17
  • Hearing Devices (effective 8/1/14) - updated exclusion language, modified BAHD criteria to allow for new devices as technology progresses, and added Bluetooth BAHD and cochlear implants and accessories to exclusions
  • Preimplantation Genetic Diagnosis (effective 8/1/14) - added language to Coverage Guidelines, added exclusions: selecting for non-medical traits and genetic conditions contributed to by donor egg and sperm
  • Scleral Lens (effective 8/1/14) - annual review
  • Oral Maxillofacial/Dental Treatment Setting (effective 10/1/14) - new clinical criteria
  • Reconstructive and Cosmetic Procedures (effective 10/1/14) - annual update; reformatted and clarified criteria; added general criteria and criteria for the face added skin redundancy removal to arms, legs, and buttocks; new criteria for varicose veins

Click Here to view all Clinical Coverage Criteria.  



Quarterly Hospital Admission Report    



The latest quarterly hospital admission report is now available for hospitals to access. Starting with this quarter's report, you can now identify patients who have CarePlus. 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 for assistance. 


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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