NHP Provider Relations is hosting a series of regional provider meetings across Massachusetts to discuss the latest news and updates from NHP. The next regional provider meeting will be held at Lowell Community Health Center. Lunch will be served.

For most office visits, NHP requires that the member's primary care provider (PCP) submit a specialist referral through NHPNet. Prior to the office visit, specialists should always verify that a valid referral number is in place.

Verifying a referral status on NHPNet is simple. In the Authorization & Referral box on the homepage, there are different ways to search for referrals:

For more information on NHP's specialist referral requirement and user guides, Click Here to view the new Referral webpage on nhp.org.

As a reminder, NHP will not accept ICD-9 codes for claims with dates of service on or after October 1, 2015.

In preparation for the ICD-10 implementation, 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.

 

Every year, NHP develops a Quality Improvement Program Evaluation. It lists specific objectives, goals, and planned activities for clinical quality improvements, service quality improvements, and patient safety. Initiatives are also designed around access and availability to ensure members receive appropriate, timely, and effective health services. At the end of each year, NHP assesses outcomes of each initiative to see if goals were achieved. The results drive the development of the following year's Quality Work Plan.
The 2015 Quality Work Plan includes a comprehensive set of initiatives encompassing preventive health, chronic disease management, and maternal child health. NHP has made progress in or sustained performance goals for the following measures:

• Poor control HbA1cs for Medicaid, Commercial and Health Connector members
• HEDIS race and ethnicity for well-child care in the first 15 months of life where well-child care (WCC) visit rates  increased for all groups
• Member satisfaction with NHPs Complex Care Management Program

Because pregnant women did not have as many postpartum visits, NHP will continue to look at ways to ensure more women will make that important appointment.

• In April 2014, NHP began a campaign to outreach postpartum members by utilizing ELIZA, a health engagement management provider, for automated telephone outreach calls.  NHP's Clinical Support Coordinators receive an ALERT file from ELIZA and the Coordinators focus their efforts on additional outreach to members who have not had or who have not scheduled their postpartum visit to facilitate the appointment.  Furthermore, the contents of NHPs Perinatal Toolkit have been amended and the toolkit is being mailed out weekly so that members receive more timely information.

For more information please go to NHP.org or contact NHP's customer service.

In preparation for CORE certification, NHP has implemented a remapping of some of our claims adjustment reasons to updated 835 CARC RARC values. These updates have also enabled us to refine some of our Patient Responsibility and Contractual Obligation determinations. We have also been able to add more clarity and specificity to claims that are denied after manual review.