To support the care coordination and treatment needs of our members, NHP will be implementing a prior authorization requirement for outpatient therapy services as listed below.

For the following services rendered on or after August 1, 2015, visits after the initial evaluation will require authorization for NHP MassHealth members:

• Physical therapy (PT)
• Occupational therapy (OT)
• Speech therapy (ST)

These outpatient therapy services rendered to NHP MassHealth members on or after August 1, 2015 without an approved authorization will result in a claims denial. For NHP MassHealth members you are currently treating, please remember that authorization will be required if the services extend through the implementation date.

Request Outpatient Therapy Authorizations through NHPNet

Requests for outpatient therapy services after the initial evaluation should be submitted via NHPNet, NHP's secure provider portal. You can also use NHPNet to submit clinical information and request additional outpatient therapy visits as needed. In the coming weeks, NHP will provide detailed educational materials on how to submit authorization requests for MassHealth members.

Register for NHPNet.org today

In addition to submitting authorization requests, you should use NHPNet to support the management of your NHP patients. From NHPNet, you can verify member eligibility prior to rendering services, check on a claims status, and access your explanation of payments. Register for NHPNet today by visiting: https://nhpnet.nhp.org/. A registration guide is available on the website for your reference. Please contact prweb@nhp.org for additional registration support.

Over the next several months, NHP will be offering additional support including webinar trainings on how to submit authorization requests for NHP MassHealth members. Information on how to register for a webinar will follow.

Effective July 1, 2015, NHP will implement 2 new medical policies that describe the criteria for:

*Devices will be authorized individually since it is expected that the member learn and gain benefit from one device before needing the other.

Click Here to view all NHP medical policies.  

For all transplant procedures, please remember that 2 separate authorizations are required:

1. An Outpatient authorization to cover the evaluation and any other outpatient transplant related services before and after the transplant itself
2. An Inpatient authorization to cover the transplant itself

Note: On both the Outpatient and Inpatient authorizations, enter the facility name in the Provider Field

 

If a member was covered for the transplant evaluation while with another health plan and then switched to NHP for the transplant, both authorizations (Inpatient and Outpatient) will still be required from NHP. 

 

As we know it can be a challenge trying to understand each health plan's authorization rules and request processes, NHP Provider Relations and Clinical staff are hosting 2 webinars in May for Skilled Nursing Facilities.

To RSVP for an authorization Webinar for Skilled Nursing Facilities, click on the link below:

Effective May 8, 2015, NHP will enter into a delegated agreement with Harvard Pilgrim Health Care (HPHC) for credentialing and re-credentialing services. Under this agreement, NHP retains the right to approve or disapprove credentialing decisions and determine which providers are allowed to enroll in NHP's network.

There is no change to the way you submit NHP enrollment and credentialing requests. Please continue to send these requests directly to NHP. We will work with HPHC to complete your request. If additional information is required, you may be contacted by an HPHC representative on behalf of NHP. During this transition, new provider requests may take up to 90 days for processing.

NHP conducts an annual survey with providers to help us better understand member access to care experiences as well as supply required reporting information to NCQA. Over the next few weeks, NHP will be reaching out to primary care and specialty practices to complete this survey. We appreciate your participation and timely responses.

Access Standards

NHP providers must ensure the availability of prompt provider consultation, including arrangements to assure coverage for members after hours. NHP also requires the hours of operation offered for all members to be the same regardless of their coverage.

The Asthma Education page on NHP.org has recently been updated. From this webpage, NHP is pleased to offer free, easy-to-understand, asthma self-management tools to support you and your patients. These materials can be ordered or downloaded in a variety of languages. Click Here to visit the Asthma Education page today.

The following medical policies have been revised and are available on nhp.org:

• Mobile Cardiac Outpatient Telemetry (effective 5/1/15) - Annual review without substantial changes in medically necessary indicators
• Phototherapy & Photochemotherapy for Dermatologic Conditions (effective 5/1/15) - Annual review without substantial changes in medically necessary indicators
• Extended Care Facility (effective 5/1/15) - New non-coverage statement for wireless accessories interfacing with bone anchored hearing devices

Click Here to view all NHP medical policies.   

 

As required by the Massachusetts Executive Office of Health and Human Services (EOHHS), providers must report provider preventable conditions to NHP. The Serious Reportable Events & Provider Preventable Conditions payment policy guideline outlines this requirement and that NHP will not pay the provider for any covered service that constitutes a provider preventable condition.

Click Here to access the Serious Reportable Events & Provider Preventable Conditions payment policy guideline. 

NHP providers use HealthTrio to enter authorizations and referrals. As a reminder, HealthTrio, LCC discontinued support of Microsoft's Internet Explorer 7 browser in 2014. For the best compatibility and provider experience, please use a later version of Internet Explorer or another web browser.

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 version of the ICD-10 readiness FAQ.

 

The latest quarterly hospital admissions 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.