Home Health Care
Evaluation/Re-Evaluation Revenue Codes
As a reminder, authorizations are not required for evaluation/re-evaluations. The following revenue codes should be used when billing for home physical, home occupational, and home speech therapy evaluations/re-evaluations:
- Home Physical Therapy Evaluation - 0424
- Home Occupational Therapy Evaluation - 0434
- Home Speech Therapy Evaluation - 0444
Home Health Visits After a 60 Day Break in Service
Currently, a new PT/OT/ST authorization is required when additional visits are requested and there is a 60 day break in service from the last authorized day. If the request for additional PT/OT/ST visits falls within 60 days of the last approved day, then the existing authorization should be revised. Starting December 1, 2015, all other home health care disciplines will align with this process. This change includes: Home Health Aide, Medical Social Worker, Private Duty Nursing, and Skilled Nursing. For these services, a new home health authorization will no longer be required when the member is admitted inpatient. A new authorization is required only when there is a 60 day break in service from the last authorized day.
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Claims Processing Enhancements
NHP is dedicated to ensuring that your claims are always processed accurately and timely, and we constantly look for ways to improve the experience for our providers. To enhance your experience with the claims process, we look to implement initiatives that are designed to reduce issues that can lead to the unnecessary use of your administrative time and resources. Corrected Claims Submission Update
Handwritten corrected claims can often times jeopardize the provider experience. As a result of being incomplete or illegible, we have seen handwritten claims contribute to slower processing times and payment errors. Effective November 1, 2015, NHP will require that corrected claims to be typed, computer generated, or electronically submitted. For the fastest processing time, we strongly recommend the electronic submission of corrected claims. Click Here to access the Request for Claims Review Form.
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You Are Invited: Regional Provider Meetings
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 meetings will be held at Lowell Community Health Center, UMass Medical School, and Holyoke Medical Center. Lunch will be served. Register today:
Northeast MA
Date:Wednesday October 7, 2015
Location: Lowell Community Health Center
161 Jackson St
CHEC Training Room (6th Floor)
Lowell, MA 01852
Central MA
Date: Friday October 23, 2015
Time: 12:00-1:30 PM
Location: UMass Medical School
55 Lake Avenue North
Amphitheater I, S2-102
Worcester, MA 01655
Western MA
Date: Friday November 6, 2015 Time: 12:00-1:30 PM Location: Holyoke Medical Center 575 Beech Street Auxiliary Conference Room Holyoke, MA 01040 RSVP: Click Here
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ICD-10 Implementation on October 1
As a reminder, all providers and payers are now expected to be ICD-10 compliant. NHP will not be accepting ICD-9 codes for claims with dates of service on or after October 1, 2015. Click Here to access the latest version of the ICD-10 readiness FAQ. The following provider payment guidelines have been revised with all references to ICD-9 codes removed:
- Coding
- Colorectal Cancer Screening: Colonoscopy
- Early Intervention Behavioral Analysis
- Nail Debridement
- Preventative Services
- Routine Foot Care
- Serious Reportable Events
- Vision Services
Click Here to view all provider payment guidelines.
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Referring Your NHP Patients into the Antidepressant Medication Management (AMM) Member Outreach Program
About This Program:
The Anti-Depressant Medication Management (AMM) Member Outreach Program is a quality improvement program administered by Beacon Health Options, NHP's behavioral health partner. 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.
- 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
How to Refer Your NHP Member into the Program:
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. Here's how you can refer your NHP members today:
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Consumer Protection From Collection Activity and Credit Reporting During the Health Insurance Appeals Process
Effective 7/1/15, Massachusetts Law requires health care providers (and their agents) to abstain from reporting a member's medical debt to a consumer credit reporting agency or sending members to collection agencies or debt collectors while an internal or external appeal is going on. This consumer protection also extends for 30 days following the resolution of the internal or external appeal.
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On behalf of all of us at Neighborhood Health Plan, we thank you for the excellent care provided to our members and the continued collaboration extended to our staff.  Helen Connaughton
Director of Provider Relations
Neighborhood Health Plan
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