November 2014
nhp.org/provider
Provider News 
openenrollment
Open Enrollment 2014-2015
Affordable Care Act
  doctors-nurses2.jpg
As a reminder, this year's open enrollment period runs from November 15, 2014 to February 15, 2015. During open enrollment, many residents will be required to select new health coverage. Impacted residents who currently obtain their insurance through the MA Health Connector or have MassHealth temporary coverage will receive mail notification of key dates and what steps they must take to avoid a gap in coverage. 

To check eligibility for subsidies, enroll in health coverage including NHP, or review important news and updates, residents should visit www.mahealthconnector.org.

Regional
You Are Invited: Regional Provider Meetings

Provider Education 


NHP Provider Relations is hosting a series of regional provider meetings across Massachusetts. Topics will include NHP products, the latest on the Affordable Care Act and open enrollment, provider tools/technology, and much more.

Register today to attend an upcoming session in your area:

Stoughton

 

Date:           Wednesday November 19, 2014
Time:          12:00-1:00 PM
Location:   New England Sinai Hospital
                    Brenner Conference Center
                    150 York Street
                    Stoughton, MA 02072
RSVP:        Click Here to RSVP


Salem

Date:          Tuesday December 2, 2014
Time:         10:30-11:30 AM
Location:   North Shore Medical Center (Salem Campus)
81 Highland Ave
Room: 102B
Salem, MA 01970
RSVP:        Click Here to RSVP
 

Hyannis

 
Date:          Thursday December 4, 2014
Time:         12:00-1:00 PM
Location:   Harbor Community Health Center
735 Attucks Lane
Hyannis, MA 02601
RSVP:        Click Here to RSVP


Greater New Bedford

 

Date:          Friday December 12, 2014
Time:         12:00-1:00 PM
Location:  Greater New Bedford Community Health Center
874 Purchase St
New Bedford, MA 02740
RSVP:        Click Here to RSVP


Please e-mail us at prweb@nhp.org if you have any questions.

HEDIS

HEDIS Data Collection Starts in January   

Reminder


The Healthcare Effectiveness Data and Information Set (HEDIS) is a widely-used standardized set of performance measures developed and maintained by the National Committee for Quality Assurance (NCQA). HEDIS was designed to help consumers compare health plan performance to other plans and to national or regional benchmarks.

Each year NHP is required to collect and report HEDIS data from contracted providers. HEDIS data collection will begin in January 2015 and end in May 2015. A member of the NHP HEDIS staff will either schedule an onsite review at your location or ask that you fax or mail the information.

Click Here to access the HEDIS FAQ

Webinars
Upcoming Webinar Trainings 

Provider Education 


Register today to attend an upcoming session:

NHPNet Training Webinar
This training focuses on the basics of NHPNet, the secure provider portal. It is intended for providers who have recently activated/re-activated their NHPNet user account or for providers who would like an overview of NHPNet.

 

Home Health Care Authorization Webinar

This training is for Home Health Care providers who would like an overview and best practice tips on submitting authorization requests.     

 

 

Paperclaims
Beginning December 1, 2014, All Claims for NHP HMO and MassHealth Members Should be Submitted Electronically, or to a New Mail Address  

Claims Reminder 


Coming soon, Neighborhood Health Plan (NHP) will be changing our address for original paper claims submissions. Starting with submissions on or after December 1, 2014, original paper claims for NHP HMO and MassHealth members should be sent to the following new address:

 

Neighborhood Health Plan

PO Box 853908

Richardson, TX 75085-3908

 

Please continue to use the current mailing address for original paper claims until November 30th. After December 1st, the current mailbox will no longer be active. All claims mailed there will be returned. For PPO members, continue to use the claims address listed on the member ID card.

For appeals, adjustments, and other correspondence, continue to mail these to 253 Summer St, Boston, MA 02210.

MCPAP
The Massachusetts Child Psychiatry Access Project
Primary Care Resources
 
The Massachusetts Child Psychiatry Access Project (MCPAP) was developed to assist Primary Care Providers' in meeting the needs of youth with Behavioral Health concerns by providing real time telephonic consultation with a child psychiatrist.  The goal of MCPAP is to help pediatricians and family physicians to effectively meet the needs of youth with common mental health conditions such as ADHD, Depression etc. 

A child psychiatrist is available via MCPAP to offer assistance with assessment, screening and diagnosis of behavioral health disorders.  If during that phone conversation, the psychiatrist determines that the case is complex, then they are able to provide a one-time face to face evaluation with the child.  As part of the care coordination services, MCPAP also provides recommendations for treatment and referrals to community resources as well as helps the family schedule appointments as needed.

All MCPAP services for pediatric or family physicians begin with a telephone call to the regional team in your area:


MCPAP REGIONAL TEAMS 
Western Massachusetts
Bay State Medical Center
413-794-3342 		Boston/Metro Region I
Massachusetts General Hospital
617-724-8282 
Central Massachusetts
UMass Memorial Medical Center
508-334-3240 		Boston/Metro Region II
Tufts Medical Center/Boston Children's Hospital
617-636-5723 
Northeast Region
North Shore Medical Center
888-627-2767 		Southeast Region
Mclean Hospital Southeast
774-419-1184 


Please visit http://www.mcpap.com/sites_index.asp to see which region your city, town, or practice is assigned. 
Depression
Depression Screening Reporting Code (S3005)    

Update


MassHealth is working in collaboration with the Department of Public Health on the depression reporting initiative. Payers are asked to share the reporting of a new code. Starting January 1, 2015, NHP's claim system will support provider reporting of depression screening with the following code:

S3005 - Performance measurement, evaluation of patient self-assessment, depression
Rx

Drug Look-up and Authorization Requirements 

Pharmacy


NHP's Drug Look-up is a useful tool for members and providers to obtain important information such as authorization requirements, dosage information, tier designations, and specialty drug forms.



2) Select the member's product and search for the requested drug

 

 

3) Drug information will appear. If there are restrictions, click on the drug name for more details 

    

 

4) Click on the restriction code(s) for more details

    

 

Restriction Code Definitions:  

QL = Quality Limit

PA = Prior Authorization Required

SP = Specialty Product (Click Here for more details)

ST = Step Therapy Program

AL = Age Limitation 

 

Clinical
Clinical Coverage Criteria       

Update


The following Clinical Coverage Criteria is available on nhp.org:
  • Gender Reassignment Surgery (effective 11/1/14) - New clinical criteria describing medically necessary indicators for Gender Reassignment Surgery

Click Here to view all Clinical Coverage Criteria.  

 

ebola
Information on Ebola        

Update


As we are all aware, West Africa is currently experiencing the largest Ebola epidemic in history. With cases confirmed in the United States over the past few months, much media attention has been focused on the containment of this illness. The Centers for Disease Control and Prevention (CDC) has released the following resources for key information, updates, and recommendation for healthcare personnel:
report

Quarterly Hospital Admissions Report    

Update


The latest quarterly hospital report is now available. 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 register online at https://nhpnet.nhp.org or contact Provider Relations at prweb@nhp.org 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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