Announcing NHP Pharmacy Enhancements to be Effective January 1, 2016
NHP continuously looks for ways to improve the service we provide to our members and to our provider network. We are excited to share the following 2016 enhancements to our pharmacy program.
CVS/caremark will become NHP's pharmacy benefit management partner
CVS/caremark will be providing pharmacy benefit management for our members starting on January 1, 2016. We are making this change because CVS/caremark offers our members access to a comprehensive pharmacy network, enhanced tools, and improved customer service.
There will be no changes to NHP's formulary, over-the-counter benefit, or Access90 program. Existing authorizations and prescriptions (excluding those for specialty medications) will be automatically transitioned to CVS/caremark. New prescriptions will not be required until the current prescriptions expire.
To ensure that specialty medications are appropriately transferred from BriovaRx to CVS/caremark, CVS/caremark will follow-up with prescribers of specialty medications over the next several weeks.
Formulary and prior authorization information can be found at nhp.org
NHP's searchable formulary and prior authorization information can now be access at nhp.org. Here you can obtain specific drug information such as the tier and any plan restrictions.
A universal prior authorization request form will be available at nhp.org
This form can be used for all medication prior authorization requests except for Synagis and Hepatitis C medications (which have their own unique forms). Starting January 1, 2016, all completed prior authorizations forms should be faxed to CVS/caremark at 866-249-6155.
New 4-tier and 5-tier pharmacy plans will be available for commercial members
Starting January 1, 2016, 4-tier and 5-tier pharmacy plan options will be available to NHP Commercial members and groups. These plan designs are intended to offer our members greater choice, access, and affordability.
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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 meeting will be held at Holyoke Medical Center. Lunch will be served. Register today:
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
Southeast MA
Date: Thursday November 12, 2015
Time: 12:00-1:00 PM Location: Greater New Bedford Community Health Center 874 Purchase Street Auditorium New Bedford, MA 02740 RSVP: Click Here
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Schedule a Postpartum Visit For Every New Mom
Ob-Gyn
The postpartum visit is an important part of overall pregnancy care. The goals of this visit are to assess the health of the mother, evaluate mother-infant bonding and breast feeding, and discuss family-planning options. A visit occurring earlier than 21 days may be too soon to reliably make these assessments, and therefore t he routine postpartum visit should occur between 21 and 56 days following delivery. Use this handy calendar to quickly tell your patients when they should make their postpartum appointment based on the delivery date. Tips to improve patient compliance:
- Make an appointment for the patient's postpartum visit while she is in her last trimester (perhaps 4 to 5 weeks before the expected delivery date)
- Schedule postpartum visit early in the post 21-56 day interval to allow time for rescheduling missed or cancelled appointments
- Schedule postpartum visit back-to-back with newborn visits if at same site
- Ask pediatric care providers to remind new moms about the importance of their own follow up
Click Here for more information on the importance of postpartum care and how to improve the postpartum HEDIS score.
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Starting in October, NHP has been reaching out to our diabetic members who have either missed their HbA1c exam or dilated retinal exam. This outreach is designed to educate the member on the importance of these exams and assist members in making an appointment with their PCP and/or an NHP contracted ophthalmologist.
In a similar program, NHP is also contacting pediatric members who have missed their well visit appointment (if the member is below the age of 18 years, a parent or guardian is contacted). If the member needs help scheduling their next pediatric visit, support staff will assist in this coordination. |
Effective October 1, 2015, providers and payers were expected to be ICD-10 compliant. All claims for dates of service on or after October 1 are no longer being accepted if submitted with ICD-9 codes. Here are some tips to remember:
- Claims that have a date range that spans the October 1st transition should be split (one claim for dates of service until Sept 30 and the second claim for dates of service starting Oct 1)
- In the ICD indicator field, use the following indicator to identify which codes are being reported:
- Enter"0" if you are reporting with ICD-10 codes (dates of service on or after 10/1/15)
- Enter "9" if you are reporting with ICD-9 codes (dates of service until 9/30/15)
Click Here to access the ICD-10 FAQ.
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The following CPT code now requires authorization for coverage:
| C9743 | Injection/Implantation of bulking or spacer material (any type) with or without image guidance (not to be used if a more specific code applies) |
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Claim 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 manual interventions. These updates will be implemented over the course of the next several months.
For example, NHP currently administers post-payment claim edits to review the appropriate payment under your rate. When a discrepancy is determined through this audit, the claims are adjusted accordingly post-payment. To reduce the overall number claim adjustments after you receive payment, NHP will look for opportunities to move certain claim edits from post-payment to pre-payment.
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Reminder: Reporting Depression Screenings
Starting in 2015, NHP reports depression screening data to the Massachusetts Department of Health and to MassHealth. Providers may document depression screenings by using the following service code and modifiers:
Service code: S3005 - performance measurement, evaluation of patient self-assessment, depression
Modifier:
| U1 | (Positive Screen) Perinatal care provider completed prenatal or postpartum depression screening and behavioral health need identified. | | U2 | (Negative Screen) Perinatal care provider completed prenatal or postpartum depression screening with no behavioral health need identified. |
| U3 | (Positive Screen) Pediatric provider completed postpartum depression screening during well-child or infant episodic visit and behavioral health need identified. | | U4 | (Negative Screen) Pediatric provider completed postpartum depression screening during well-child or infant episodic visit with no behavioral health need identified. |
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The following medical policies have been revised (effective 11/1/15) and will be available on nhp.org:
- Acupuncture (MassHealth) - Annual review without substantial changes. References updated.
- Gender Reassignment Surgery (All products) - Annual review. Added definition of Gender Identity. Minor changes for language on exclusions. References updated.
- Infertility Services (Commercial and Qualified Health Plans) - The condition that the intention is to transfer the eggs/embryos back to the member in order to meet IVF for members not in active infertility treatment but are undergoing medical treatment that renders them infertile was removed.
Click Here to view all NHP medical policies.
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Quarterly Hospital Admission Report
The latest quarterly hospital admissions report is now available. To review 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 nhpnet.org.
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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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