Attend a PT/OT/ST Webinar
As a reminder, NHP MassHealth members will need a prior authorization to continue physical therapy, occupational therapy, or speech therapy after the initial evaluation starting on August 1, 2015. This includes when these services are provided in a home setting. NHP MassHealth members have identification cards with a blue banner (as shown in the picture to the right). NHP Commercial members will not need prior authorization for these services.Request Authorizations Quickly and Easily on NHPNet Beginning August 1, 2015, you will be able to enter prior authorizations for these services through NHPNet, our secure provider portal. We understand that appointments are often scheduled weeks in advance, and we are allowing a transition period for August service dates. For August appointments scheduled, you may submit the authorization request retroactively until August 30, 2015. To avoid a claim denial, claims should only be submitted after you obtain prior authorization. Starting on September 1, 2015, prior authorizations must be requested before the date of service or the claim will deny. Attend a Free Webinar To support you through this transition, NHP will host training webinars to review the authorization submission process: Outpatient PT/OT/ST Authorization Webinars
- July 8, 2015 @ 2:30-3:30 PM - Registration Is Now Closed
- August 10, 2015 @ 10:00-11:00 AM (Click Here to RSVP)
Home Health Care PT/OT/ST Authorization Webinars
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Length of Stay Extension Requests
Authorization
As a reminder, to request an extension to the length of stay of an admission, the following steps are required: Step 1) The request for additional days must be submitted through HealthTrio as a revision to the existing authorization. Starting in July, an administrative denial will be issued if the request for additional days is not entered into HealthTrio.
Step 2) Requests for additional days will require additional clinical notes to be submitted. For the fastest review turnaround, NHP recommends that additional clinical notes be uploaded directly to the authorization in HealthTrio. If you cannot upload clinical notes into HealthTrio, additional clinical notes can be faxed to 617-586-1700. Faxed clinical notes should include the authorization number on the fax cover page.
For detailed information on how to request an extension and upload clinical notes, Click Here to access the HealthTrio User Guide.
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Specialist Referral Requirement
Reminder
Primary Care Providers (PCP) are often the patient's first point of contact for addressing health concerns or for planning preventative services, and they are essential to the management of their patient's overall health needs. The PCP is responsible for providing, arranging for, and coordinating the provision of covered services. For most non-emergent and non-routine office visits to other providers, a specialist referral is required from the PCP. The referral requirement is in place to ensure that the PCP plays an active role in facilitating the member's care. To obtain a specialist referral, the PCP should submit the request through NHPNet. Click Here to access the HealthTrio User Guide for Specialist Referrals.
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Durable Medical Equipment Authorization Updates
Authorization
Updated Fax Line To streamline the durable medical equipment (DME) authorization process with the processes of other services, the dedicated DME fax line will no longer be active starting September 1, 2015. Prior authorization requests for DME should be submitted through NHPNet. For instances when a request cannot be submitted through NHPNet (ex: out-of-network), please fax your request to the main authorization submission fax line at 617-586-1700. DME Authorization FormNHP's DME authorization request form will no longer be available for use. Authorization requests for DME should be submitted via NHPNet. For requests that cannot be submitted via NHPNet such as when the service is out-of-network, please utilize the Standardized Authorization Request Form. DME Coverage and Prior Authorization RequirementsThe following codes have been updated: - S8270 Enuresis alarm, using auditory buzzer and/or vibration device (Bed Wetting Alarm) - Effective 8/1/15, this device will require prior authorization
- 0191T Insertion of anterior segment aqueous drainage device, without extraocular reservoir, internal approach, into the trabecular meshwork; initial insertion - Effective 4/24/15, this device will be covered by NHP. No prior authorization is required
- 0376T Insertion of anterior segment aqueous drainage device, without extraocular reservoir, internal approach, into the trabecular meshwork; each additional device insertion (List separately in addition to code for primary procedure) - Effective 4/24/15, this device will be covered by NHP. No prior authorization is required
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Fluoride Varnish Billing Code Change
MassHealth and Commercial
As a reminder, MassHealth recently announced that CPT service code 99188 (topical application of fluoride varnish by a physician or other qualified health care professional) with ICD-9 diagnosis code V07.31 has now replaced service code D1206. To align with MassHealth, providers who submit claims for the application of fluoride varnish in a medical setting for members (6 months to 21 years of age) should now use 99188 for NHP MassHealth and Commercial members.
Starting with claims billed after June 30, 2015, claims submitted for NHP MassHealth or Commercial members with service code D1206 will deny.
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Primary Care Provider Changes
NHPNet
Did you know that NHPNet allows primary care providers (PCP) to move NHP members from their panel to another PCP with an open panel within the same group?  Click Here to access the NHPNet User Guide for detailed instructions.
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Resetting Your NHPNet Password and Security Question
NHPNet
NHPNet users have the ability to reset their NHPNet password and Security Question. To update this information, follow these quick and easy steps:
1) Go to "Your Profile" from the Resources Tab:
2) Under Account Setting, you can choose the option to "Reset My Password" or "Reset My Security Question"
Password Notes:
- Passwords must be between 8 and 128 characters long
- Passwords must contain at least one lower case letter, one upper case letter, and one number
- Passwords cannot contain your login name
Security Question Notes:- Security Questions must be between 4 and 256 characters long
- Answers cannot have any characters that repeat 3 or more times in a row
- Security Questions cannot contain your login name
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Available Cost Transparency Tools for Members
Reminder
Cost Estimate Worksheet The Massachusetts Collaborative recently created a standardized Cost Estimate Worksheet to help patients capture the information necessary to obtain cost estimates for services, procedures, and admissions. In addition, this tool outlines tips and common terminology for patients to better understand the cost of care. We encourage you to complete and review this worksheet with your patients for their reference.  Online Cost Estimate Tool As an additional resource, NHP offers an online cost estimate tool for all our members. This online tool is accessible through our member portal. Members can sign up for our member portal today by going to NHP.org and following the registration instructions. 
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Satisfaction Surveys
Update
Office Manager SurveyEach year, Neighborhood Health Plan, with assistance from the independent market research firm Market Measurement, Inc., conducts a telephone survey to identify the ways in which we can better serve your needs. This year's survey will be conducted over the next several weeks. Your responses will remain completely confidential, as only summary data will be shared with Neighborhood Health Plan. The survey will take only about ten minutes. Hospital SurveyDuring this same period, NHP will be conducting our annual hospital satisfaction survey. Topics covered in the survey will include your experience with NHP's authorization process, claims, and customer service. The survey will be conducted online and will take approximately ten minutes. We thank you in advance for your participation!
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48 Hour Observation
Payment Policy
As a reminder, NHP MassHealth and Commercial members will be covered for observation stays for up to 48 hours starting with services on or after August 1, 2015. Coverage will include the addition of the following codes: |
CPT Code
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Description
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99224
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Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: Problem focused interval history; Problem focused examination; Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is stable, recovering, or improving. Typically, 15 minutes are spent at the bedside and on the patient's hospital floor or unit.
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99225
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Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Typically, 25 minutes are spent at the bedside and on the patient's hospital floor or unit.
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99226
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Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is unstable or has developed a significant complication or a significant new problem. Typically, 35 minutes are spent at the bedside and on the patient's hospital floor or unit.
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Expanded Chiropractic Benefit
Payment Policy
NHP has updated our provider payment guidelines (PPG) for Chiropractic Care. The revised policy will be available at nhp.org within the next few weeks. To align with the Affordable Care Act (ACA) regulations, NHP has expanded the chiropractic coverage for NHP Commercial members who have a chiropractic benefit. Effective for services rendered on or after January 1, 2014, services outlined in the updated PPG will be covered. Expanded coverage includes all levels of evaluation & management and therapeutic services. NHP will reprocess eligible Commercial claims with dates of service on or after January 1, 2014. This claims reprocessing will occur over the next several months. The reprocessed claim lines will appear on your explanation of payment with the remittance message: "Reprocessed Per ACA. See Chiro PPG." For services rendered on or after July 15, 2015, NHP's claims system will be reconfigured to process these service codes for NHP MassHealth and Commercial members who have chiropractic benefits. Please remember to always verify member benefits and eligibility prior to rendering services.
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Hepatitis C Medications
Pharmacy
The Hepatitis C Medications policy has been updated and is now available for your reference. Click Here to view the updated policy.
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Medical Policy Updates
Clinical
The following medical policy has been revised and is available on nhp.org: - Infertility Services (Commercial and Qualified Health Plans) - effective 7/1/15
- Coverage and criteria added for cryopreservation of eggs, embryos and sperm for members undergoing medical treatment, excluding voluntary sterilization, that is likely to result in permanent infertility, and NHP has authorized an IVF cycle for stimulation and retrieval. Cryopreservation of eggs, embryos and sperm will be covered for up to one year from the time of the egg or sperm retrieval.
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Coverage for one cycle of IVF for the purpose of egg retrieval, processing and fertilization and a single cryopreservation of eggs/embryos for up to one year, when there is documentation that a member will be undergoing medical treatment (e.g. chemotherapy, radiation), excluding voluntary sterilization and past voluntary sterilization, that is likely to result in permanent infertility.
Click Here to view all NHP medical policies.
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Urgent Field Safety Notice
Adaptive Servo Ventilation Therapy
Based upon preliminary results of the SERVE-HF clinical trial, ResMed Ltd. has identified an increased risk of cardiovascular death in patients with symptomatic chronic heart failure (NYHA 2-4) with reduced left ventricular ejection fraction (LVEF</ 45%), and moderate to severe predominant central sleep apnea (Apnea-Hypopnea index >/15, Central Apnea Index >/10, CAHI/AHI >/50%) who are being treated with Adaptive Servo Ventilation (ASV) therapy.
Use of ASV is contraindicated in this class of patients. Providers are being asked to consider discontinuing ASV therapy in this group of patients given the increased risk of sudden cardiac death.
NHP is currently evaluating the ResMed SERVE-HF study data. If your patient is using ASV therapy, they should be taken off if they have symptomatic congestive heart failure. This risk is independent of the patient's perceived benefit, or duration on therapy.
This warning does not apply to members who do not have symptomatic heart failure, and it does not apply to those with CPAP and APAP devices.
Additional information for ResMed Field Safety Notice can be found at:
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CareCore | MedSolutions is now eviCore healthcare
Reminder
As part of a rebranding and re-naming initiative that will further advance the company's commitment to contain healthcare costs and help achieve quality outcomes, CareCore National | Medsolutions is now eviCore healthcare.
There will be no changes to how you submit prior authorizations, and you may continue to use the same website as you do today. Over the next few months, you will notice a change to the logos that appear on the websites and letters.
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According to a CDC survey, postpartum depression affects as many as 8-19% of women while symptoms of postpartum blues may occur in 40 to 80% of women
Postpartum Depression
Postpartum blues generally occur within a few days of delivery and last for several days to a couple of weeks at most. Symptoms may include brief crying spells, irritability, poor sleep, nervousness, and emotional reactivity. Those who develop postpartum blues are at increased risk to develop postpartum depression. According to Hurst and Moutier:
Symptoms of postpartum major depression may differ from nonpostpartum major depression. Women with postpartum major depression are less likely to report feeling sad, but have notable feelings of guilt or worthlessness, and a lack of enjoyment or interest in pleasurable activities. Decreased energy and disrupted sleep related to infant care may be difficult to differentiate from symptoms of depression. Asking a mother whether she can sleep when her infant sleeps at night may provide clarification, because many women with postpartum major depression have difficulty falling or staying asleep. Although sleep disruptions can also lead to mild transient problems in memory and concentration, persistent difficulty with concentration or cognitive tasks is indicative of a mood disorder. Changes in appetite are unreliable in making a diagnosis.
The most commonly used validated screening tool for postpartum depression is the Edinburgh Postnatal Depression Scale. The Edinburgh Postnatal Depression Scale is available in several languages and may be downloaded free from multiple sources, including the University of California, San Francisco, Fresno, Web site (http://www.fresno.ucsf.edu/pediatrics/downloads/edinburghscale.pdf). For those who screen positive and may require further evaluation,management and treatment, please contact Neighborhood Health Plan's behavioral health partner, Beacon Health Strategies, at 800-414-2820 for behavioral health resources.
Additionally, beginning in 2015 Postpartum Depression screening data must be reported to the
Massachusetts Department of Public Health (MDPH) with the first reporting due March 2016 covering calendar year 2015. Neighborhood Health Plan will be reporting Postpartum Depression Screening claims directly to the All Payer Claims Database (APCD) at CHIA. Providers may report Postpartum Depression Screening to NHP by using the HCPCS code of S3005 (Performance Measurement, Evaluation of Patient Self-Assessment, Depression) with a diagnosis code for Postpartum care and examination (V24.0 immediately after delivery, V24.1 Lactating mother or V24.2 Routine postpartum follow-up) and a modifier as designated by the MDPH:
Risk factors for postpartum depression include:
- Postpartum depression with a prior pregnancy
- Antenatal depressive symptoms and/or major depression
- Poor social supports
- Major life events/stressors during pregnancy, among others
Some useful references:
Postpartum Depression Toolkit
http://www.aafp.org/patient-care/nrn/studies/all/trippd/ppd-toolkit.html
Postpartum Depression in the Beacon Health Options PCP Toolkit
http://www.beaconhealthstrategies.com/pcp_toolkit/pcp_toolkit.aspx
KATHRYN P. HIRST, MD, and CHRISTINE Y. MOUTIER, MD, University of California, San Diego, School of Medicine, La Jolla, California Am Fam Physician. 2010 Oct 15;82(8):926-933.
http://www.aafp.org/afp/2010/1015/p926.html
Massachusetts Department of Public Health, Postpartum Depression
http://www.mass.gov/eohhs/gov/departments/dph/programs/family-health/postpartum-depression/
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ICD-10 Compliance Testing
Reminder
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.
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