The PPO option is offered alongside our HMO products to small and large employers across the state. PPO plans allow members to seek services within a PPO network, but also allows the flexibility to seek out-of-network care. NHP has partnered with MultiPlan, Inc to provide national coverage for the PPO option. MultiPlan's Private Healthcare Systems (PHCS) PPO network is available for in-network coverage.



Click Here to access a fact sheet on how to service a PPO member.

As a reminder, ICD-10 implementation is scheduled for October 1, 2015. NHP is currently accepting requests for EDI 837 transaction compliance testing. End-to-end testing will be comprised of adjudicating claims and returning 835 remittance advice transactions. If you would like to participate in EDI compliance testing, email Vincent Chiachio at vincent_chiachio@nhp.org.

Click Here to access the latest ICD-10 Readiness FAQ.

 

Beacon Health Strategies, NHP's behavioral health partner, has developed a toolkit to assist PCPs in the screening, diagnosis and treatment of mental health and substance use disorders.

Primary care settings are, at times, the first line of identification for behavioral health issues and PCPs are the center of care for many patients who have both physical and behavioral health disorders. This online toolkit supports PCPs by assisting in identifying BH conditions through well-known screening tools as well as providing decision support as appropriate. It also includes condition-specific fact sheets as well as other patient-centered information for PCPs use in helping their patients understand their diagnosis and take the right steps to become and stay healthy.

The conditions included in the toolkit are:

• Alcohol and other drugs
• Anxiety
• ADHD
• Depression, adolescent depression and postpartum depression
• Eating disorder
• OCD
• PTSD
• Schizophrenia

It is important to coordinate and collaborate with other providers to ensure patients are getting the best care possible. To facilitate integrated care, this toolkit has forms that will allow PCPs to share relevant patient information with other providers, including BH providers. The form can be found on Beacon's website at: http://beaconhealthstrategies.com/pcp_toolkit/pcp_toolkit.aspx. 

 

In some cases, it may be necessary for NHP to close an authorization request without further processing. For example, if an authorization request is submitted and it is determined that there is no authorization requirement for the service, the request will be closed.

New closure reason codes have been created to provide you with additional information. Below are the closure reason codes that you may see in NHPNet:

• AC - Duplicate (Check NHPNet for the original authorization/referral)
• AC - No Prior Authorization Required
• AC - Revision of Existing Authorization Required
• AC - Status Changed (example: inpatient to observation)
• AC - Submit on Census
• AC - Template/Service Mismatch - See User Guide and Resubmit

As a reminder, MassHealth is required to review and re-determine member benefits on an annual basis. Due to system issues, this process was suspended starting in the Fall of 2013. With improved system functionality, MassHealth has reinstated regular renewals using Modified Gross Adjusted Income (MAGI) methodologies for all non-disabled and non-senior members.

Members who qualify for automatic renewals will be notified that no further action is required. For those who must reapply, MassHealth will send out a notification with instructions on when and how to submit their renewal application. For the fastest way to reapply for coverage, it is recommended that members submit their application online at MAhealthconnector.org. Members who do not reapply by the specified deadline will lose coverage.

Checking Member Eligibility

As a member's eligibility status can change from one day to another, it is best practice to regularly verify eligibility. Please remember to always check member eligibility in NHPNet, the secure provider portal, prior to rendering services. NHPNet provides you with the latest eligibility information.

For additional assistance through the renewal process, MassHealth members can contact the MassHealth Customer Service Center at 1-800-841-2900 (TTY: 1-800-497-4648).