
Outpatient Therapy Authorization Requirement
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 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
Home Health Care PT/OT/ST Authorization Webinars
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Fluoride Varnish Billing Code Change
MassHealth
MassHealth 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. Providers who submit claims for the application of fluoride varnish in a medical setting for MassHealth members (6 months to 21 years of age) should now use 99188 with V07.31. Starting with claims billed after June 30, 2015, claims submitted with service code D1206 will deny.
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Wait Time Access Survey
Reminder
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. Primary care and specialty practices are asked to provide information on available appointment dates and times. Completed entries will be entered to win a Fitbit. We appreciate your participation and timely responses. Click Here to complete the survey today.
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Observation Payment Policy
Update
NHP has updated our Observation Provider Payment Guidelines, effective August 1, 2015. The revised policy will be available at nhp.org within the next few weeks. To align with industry standards, 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. Notification to NHP will still be required within the next business day of the observation stay admission. Requests should be entered through NHPNet, NHP's secure provider portal. Click Here to find detailed instructions on how to submit notification requests.
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Specialist Referrals
Reminder
For NHP MassHealth and Commercial members seeking specialist care (non-emergent and non-routine), a specialist referral issued by the member's primary care provider (PCP) is required. This includes visits to a specialist within the same group as the member's PCP. Referral requests can be submitted through NHPNet, NHP's secure provider portal. Referrals are not required for:
- Urgent and emergent services
- Care provided by a specialist while the member is in the hospital
- Family planning services
- Routine eye exams
- Care delivered in an OB/GYN office visit (routine, preventative, and urgent)
- Outpatient and diversionary behavioral health services
- Special Kids Special Care (SKSC) Pediatric Program
Click Here to access the Specialist Referral User Guide.
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Provider Enrollment and Credentialing Webpage
Update
NHP is excited to announce that a new provider enrollment and credentialing webpage is now available for your reference. Providers can use this webpage to review enrollment and credentialing processes and access common forms such as the Standardized Provider Information Change form. For providers who are not currently part of NHP's network, this webpage outlines the steps on how to become an NHP provider. Click here to view the Provider Enrollment and Credentialing webpage today.
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Delegation of Credentialing Operations
Reminder
Effective May 8, 2015, NHP entered 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 at pec@nhp.org. 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.
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UB-04 Claims Rejections
Claims
Often times, claims reject for missing or incomplete information. As a result, these claims will not make it into NHP's claims system until these discrepancies are corrected. For UB-04 claims, we see more rejections when the Health Plan Identification Number is not provided. When you enter the Payer Name (Box 50), the Health Plan Identification Number (Box 51) must be included as well. Conversely, if Box 51 is completed then Box 50 must also be completed. Please ensure that if these fields are used, they are populated with appropriate secondary payer information.
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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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