Accessing Your Provider Roster Report
Provider Enrollment 
The Provider Site Roster Report on NHPNet, the secure provider portal, is available for provider sites to verify the latest listing of their providers who are enrolled and credentialed with NHP.
Use this report to verify a provider's enrollment status. For completed provider enrollments, you will see the provider's name and effective date listed. To ensure accurate payment, providers should not provide services to NHP members prior to their effective date.
To access the Provider Site Roster Report, log onto NHPNet. Under the Reports tab, click on Enrollment Reports.
Please contact prweb@nhp.org if you have questions about accessing your Provider Roster Report.
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Checking Member Eligibility
Update
Members who obtain their health coverage through the MA Health Connector are required to pay monthly premiums. If a member fails to pay their premium timely, they have up to 3 months to settle their account. During this period, Health Plans are required to notify you when a member is in a payment delinquency status and there's a possibility that claims for services rendered during this time will deny. NHP will notify you if a member is in a delinquency status through the following ways: - Prior to rendering a service, always verify eligibility on NHPNet. Members who are in a delinquent status will show as: "Active - PI*" on the member eligibility search screen:
 If you view a member's detail page, the eligibility status will indicate " Active - Pending Investigation" and the member's delinquency effective date will be displayed:  - For Medical and Behavioral Health services rendered while a member is in a delinquent status, the claim will pend and indicate that the "member has an active restriction on enrollment":
- All Pharmacy claims submitted when a member is in a delinquent status will deny.
If the member settles their account prior to the end of the 3rd month, their eligibility status becomes "Active" and all pended claims will process. If the member fails to settle their account prior to the end of the 3rd month, their eligibility status becomes "Inactive" and all pended claims will deny.
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Form 1099-MISC To Be Mailed Out By Week of February 23
Update
In accordance with IRS regulations, please be advised that form 1099-MISC (Miscellaneous Income) will be mailed by the week of February 23, 2015. Please allow 10 business days for delivery. Additional copies will be available beginning on March 9, 2015. Please contact NHP Provider Services at 855-444-4647 or providerservice@nhp.org with any questions.
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Reminder - Section 1202 Enhanced Payments End 12/31/14
Update
As a reminder, NHP implemented ACA Section 1202 enhanced rates for calendar years 2013 and 2014. On 12/31/14, these enhanced rates are set to expire. Providers who were receiving enhanced rates will receive the standard NHP physician rates for Medicaid members for dates of service starting January 1, 2015 and after.
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2015 Preventative Benefit Updates
Commercial
Starting January 1, 2015, the following benefits will be updated for Commercial plans (for GIC members, these changes will be implemented on July 1, 2015): New Preventative Benefits:- Fluoride Varnish - NHP will cover the application of fluoride varnish at the PCP's office up to 4 times per year for members 6 months to 18 years of age.
- Lung Cancer Screening by Low Dose CT Scan - Adults ages 55-80 are covered with a prior authorization. No cost sharing will be applied for members who qualify.
Revised Preventative Benefits:
- Hepatitis B Screening - Hepatitis B screenings benefit has been expanded to include non-pregnant teens and adults who are at a high risk of becoming infected with Hepatitis B. Additional lab tests for Hepatitis B will have no cost sharing.
- Tobacco Cessation Counseling - Telephonic smoking cessation counseling has been added to this benefit as an additional method of delivering counseling.
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Radiology Approval Notifications
MedSolutions, Inc
MedSolutions, Inc, NHP's vendor for radiology services, recently announced enhancements to their provider web portal. Providers will now receive an e-mail notification for all approved cases that are initiated through the web portal. To protect our member's information, this new functionality is fully HIPAA compliant with no protected health information shared through the e-mail notification. You will continue to receive faxes for all denials and requests that are not initiated through the web portal.
To receive e-mail approval notifications, you must be registered with a valid e-mail address on the MedSolutions web portal. If an approval notification e-mail is undeliverable, a fax notification will be sent.
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Reminder - All Claims for NHP HMO and MassHealth Members Should be Submitted Electronically, or to a New Mail Address
Claims
NHP has changed 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 The old mailbox is no longer active. All claims mailed there will be returned. For PPO members, continue to use the claims address: PO Box 852099, Richardson, TX 75085-2099.
Some Electronic Medical Record systems (EMRs) require inclusion of a payer's physical address. Please ensure your systems are updated accordingly.
For appeals, adjustments, and other correspondence, continue to mail these to 253 Summer St, Boston, MA 02210.
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Effective January 1, 2015, the following codes require prior authorization: |
22510
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Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; cervicothoracic
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22511
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Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; lumbosacral
| 22512
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Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; each additional cervicothoracic or lumbosacral vertebral body (List separately in addition to code for primary procedure)
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22513
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Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; thoracic
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22514
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Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; lumbar
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22515
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Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; each additional thoracic or lumbar. vertebral body (List separately in addition to code for primary procedure)
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22858
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Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection); second level, cervical (List separately in addition to code for primary procedure)
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Effective January 1, 2015, the following codes will not be covered: |
33270
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Insertion or replacement of permanent subcutaneous implantable defibrillator system, with subcutaneous electrode, including defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters, when performed
| 33271
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Insertion of subcutaneous implantable defibrillator electrode
| 33272
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Removal of subcutaneous implantable defibrillator electrode
| 33273
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Repositioning of previously implanted subcutaneous implantable defibrillator electrode
| 34839
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Physician planning of a patient-specific fenestrated visceral aortic endograft requiring a minimum of 90 minutes of physician time
| 52441
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Cystourethroscopy, with insertion of permanent adjustable transprostatic implant; single implant
| 52442
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Cystourethroscopy, with insertion of permanent adjustable transprostatic implant; each additional permanent adjustable transprostatic implant (List separately in addition to code for primary procedure)
| 64486
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Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) unilateral; by injection(s) (includes imaging guidance, when performed)
| 64487
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Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) unilateral; by continuous infusion(s) (includes imaging guidance, when performed)
| 64488
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Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) bilateral; by injections (includes imaging guidance, when performed)
| 64489
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Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) bilateral; by continuous infusions (includes imaging guidance, when performed)
| 77061
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Digital breast tomosynthesis; unilateral
| 77062
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Digital breast tomosynthesis; bilateral
| 77063
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Screening digital breast tomosynthesis, bilateral (List separately in addition to code for primary procedure)
| 77085
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Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine), including vertebral fracture assessment
| 77086
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Vertebral fracture assessment via dual-energy X-ray absorptiometry (DXA)
| 90630
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Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intradermal use
| 90651
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Human Papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent (HPV), 3 dose schedule, for intramuscular use
| 92145
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Corneal hysteresis determination, by air impulse stimulation, unilateral or bilateral, with interpretation and report
| 93260
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Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; implantable subcutaneous lead defibrillator system
| 93261
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Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter; implantable subcutaneous lead defibrillator system
| 93644
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Electrophysiologic evaluation of subcutaneous implantable defibrillator (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters)
| 93702
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Bioimpedance spectroscopy (BIS), extracellular fluid analysis for lymphedema assessment(s)
| 93895
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Quantitative carotid intima media thickness and carotid atheroma evaluation, bilateral
| 0377T
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Anoscopy with directed submucosal injection of bulking agent for fecal incontinence
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Effective January 1, 2015, the following codes are covered, but not separately payable. Members should not be billed for covered services which are not separately payable: 96127
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Brief emotional/behavioral assessment (eg, depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument
| 99497
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Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate
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99498
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Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; each additional 30 minutes (List separately in addition to code for primary procedure)
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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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