PT/OT/ST 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 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 Prior authorizations for these services must be entered through NHPNet, our secure provider portal.
Note: NHP's systems were recently updated to accommodate this prior authorization change. To view the system updates, you may need to refresh your web browser (or delete your browsing history) and log back in.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 Webinar Home Health Care PT/OT/ST Authorization Webinar
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NHP Partners with CVS/Caremark for Pharmacy Benefit Management Services
Pharmacy
NHP recently announced CVS/Caremark as our new Pharmacy Benefit Manager, effective January 1, 2016. CVS Caremark is an innovator and industry leader, with a reputation for excellent customer service and medication management tools. NHP and CVS Caremark are developing plans to ensure a smooth transition for our members. We will share more information with you as soon as it becomes available. There is no action required at this time. Click Here to read the press release.
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Out-of-Network Laboratories
Reminder
When referring an NHP member for lab work, please remember to always select an in-network laboratory to provide these services. Services that are performed by an out-of-network lab may not be covered and may result in balanced billing to the member. For a list of in-network labs, please access NHP's Find a Doctor tool.
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Specialist Referral Webpage
Update
We are excited to announce a new webpage on NHP.org that centralizes available resources and information related to specialist referrals. On this webpage, you will find easy access to the following information: - Referral requirements
- User guides on how to submit/verify the status of a referral
- Roles of the Primary Care Provider and Specialist
Click Here to view the page. 
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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. Click here to access the updated Observation Services Payment Policy.
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Checking the Status of A Claim
NHPNet Tips
NHPNet, the secure provider portal, offers you access to the latest status update of your submitted claims. 1) From the homepage, hover your cursor over the red callout box in the Claims Status section  2) A pop-up of your latest submitted claims summary will appear  For more details, click on the available links that appear in the pop-up. You can also search by a specific claim number, search by a member ID number, or run a report of all claims for your site. Click Here to access the NHPNet User Guide for detailed instructions.
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MassHealth Renewals
MassHealth
As a reminder, MassHealth is required to review and re-determine member benefits on an annual basis. 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 EligibilityAs 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).
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Wait Time Access Survey Winner
Update
Thank you to all providers who completed the Wait Time Access Survey! NHP sends out this annual survey to primary care providers and specialists. The information collected helps NHP better understand the member wait time experience at provider offices and supplies us with required reporting information to NQCA. As a reminder, below are the standards and expectations established for appointment wait times for our members: |
Type of Care
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Primary Care Provider
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Specialist
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Urgent
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Within 48 hours
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Within 48 hours
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Non-urgent
(symptoms)
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Within 10 days
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Within 30 days
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Well or preventative visit (no symptoms)
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Within 45 days
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Within 60 days
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All completed responses were entered into a raffle drawing. Congratulations to Danielle Bridgestock of Hyannis Family Medical Care for winning a FitBit!
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Medical Policy Updates
Clinical
The following medical policies have been revised (effective 8/1/15) and will be available on nhp.org: - Preimplantation Genetic Testing (Commercial) - Annual review without substantial changes in medically necessary indicators
- Hearing Devices (All Plans) - Clarification of criteria for replacement or repair of air conduction hearing aids, non-implantable bone anchored hearing devices
- Home Health Care (All Plans) - Annual review without substantial changes in medically necessary indicators
- Scleral Lens - (All Plans) - Annual review without substantial changes in medically necessary indicators
Click Here to view all NHP medical policies.
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Antidepressant Medication Management (AMM) Member Outreach Program
Referral Information
NHP and its Behavioral Health Partner, Beacon Health Strategies (Beacon) are pleased to announce the availability of a program to improve medication adherence for members who are prescribed antidepressants. The Anti-Depressant Medication Management (AMM) Member Outreach Program is a Quality Improvement program administered by Beacon. Trained health coaches provide telephonic member outreach to enrolled members. NHP Members may benefit from participation by having a successful outcome associated with improved adherence for their newly prescribed antidepressant medication therapy. As a provider, you have the opportunity to refer and enroll eligible NHP members in this program. Referring prescribers will receive a monthly status report for all members you have referred. Eligible members must: - Be an NHP member and at least 18 years of age
- Have been recently (within last 30 days) prescribed an antidepressant which was filled at a pharmacy
- Be starting a new course of prescription antidepressant treatment and thus have NOT filled a prescription for an antidepressant medication in the immediately preceding 90 days from when the new prescription was filled
Questions about this program or requests for referral/enrollment forms may be directed to 781-994-7572 or by email at pdipamm@beaconhs.com.
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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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Quarterly Hospital Admissions Report
Update
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.
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