For members with MassHealth or a Commercial plan that has prescription drug coverage, NHP covers many over-the-counter (OTC) products when a prescription is obtained. Covered OTC products are available at participating pharmacies in NHP's network.

For NHP MassHealth members, covered items are available in quantities up to a 30-day supply for a $3.65 copay. Click Here to see the covered OTC products for MassHealth.

For Commercial members with prescription drug coverage, covered items are available in quantities up to a 90-day supply at various cost-sharing amounts. Click Here to see the covered OTC products for Commercial.

Note: The OTC listings include brand names. When available, the generic product must be prescribed.
 

The following medical policy has been revised and is available on nhp.org:

• Absorbent Products for Incontinence (effective 4/1/15) - Annual review without substantial changes in medically necessary indicators

Click Here to view all NHP medical policies. 

The Prior Authorization, Notification, and Referral Guidelines have recently been updated. The changes include the following:

• Implantable Neuro-Electrodes are now listed as Neurostimulators
• All references to Commonwealth Care have been removed

Click Here to access the latest version. 

 

Last year, over 400 telephone surveys were conducted with office managers and physicians. Providers were asked about their thoughts related to NHP's operations, care management programs, utilization management, timeliness of decision-making, and ease of processes.

With 92% of office managers indicating that they were satisfied or very satisfied with NHP overall, the 2014 findings include high marks specific to:

• Timely claims payment
• NHPNet ease of use
• Customer service

With your feedback, we have identified areas of potential focus, including:

• Increase provider training opportunities
• Increase provider portal capabilities (such as adding new functionality for authorization requests)

Thanks to all study participants for their input. We look forward to continually improving the services we provide to our network during 2015.

As a reminder, NHP provides comprehensive breastfeeding support to members including: breastfeeding education classes, ongoing support through network providers, and breast pumps and supplies covered with no member cost sharing. NHP now covers up to three (3) visits with a certified lactation consultant for members who may need additional support:

CPT Code: S9443 - Lactation classes, non-physician provider, per session
Authorization Required: No
Referral Required: No
Member Cost Sharing: None
Limit: 3 visits

Members may request a reimbursement for a lactation consultant visit. To initiate this request, the member must complete and submit the Member Reimbursement Claim Form.

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.

The ICD-10 Readiness FAQ has recently been updated. Click Here to access the latest version.