Surgical Authorization Submissions (Effective 4/1/16)
Servicing Provider Field
As of April 1, 2016, the requesting provider must enter both the facility and the specialist into the Servicing Provider field when submitting requests online. This will automatically generate separate prior authorization numbers to the facility and to the specialist, and ensure that the corresponding claims appropriately match. It is no longer necessary to enter the surgeon's name and NPI in the Remarks field.  Submitting Surgical Requests
As a reminder, surgical authorization requests must be submitted by the rendering specialist. Surgical authorization requests initiated by the patient's Primary Care Provider (if the Primary Care Provider is not performing the surgery) will be closed and will not be processed.
For additional information, please see our Inpatient and Outpatient Authorization User Guides:
Surgical Authorization Request Webinars
To support you with this change, NHP Provider Relations and Clinical staff are hosting a webinar to review the process. To attend this webinar, RSVP by clicking on the link below.
Date: April 6, 2016
Time: 12pm-12:30pm
RSVP: Click Here
|
Perinatal Screening Reimbursement
Effective May 1, 2016, NHP will reimburse providers for the perinatal screening code S3005 for MassHealth members; limits apply. This change applies to claims with a date of service on or after May 1, 2016. S3005 remains non-reimbursable for Commercial/ QHP member claims.
|
Chiropractic Benefit Update for MassHealth Members
Effective June 1, 2016, the MassHealth Chiropractic benefit will be limited to 20 visits per benefit year (October 1 -September 30). Existing authorizations that extend past June 1, 2016, will remain in place. New authorization requests for visits that exceed the 20 visit benefit limitation on or after June 1, 2016 will not be considered.
|
 NHP Launches Pilot Programs to Aid Recovery of Patients with Serious Mental Illnesses and Substance Use Disorder NHP recently announced it is funding two innovative pilot programs with its behavioral health partner Beacon Health Options (Beacon) to provide peer support to fill the unmet medical needs of patients who suffer from substance use disorders and serious and persistent mental illnesses.
Here-for-You Program
NHP and Beacon launched the Here-for-You, which aims to reach up to 10,000 NHP members suffering with serious and persistent mental illness, specifically Psychotic or Bipolar Disorders.
Here-for-You provides care coordinators in community mental health centers where these patients receive most of their care. Integrated teams target a patient's most immediate and crucial needs, then customize a culturally and linguistically-appropriate treatment plan that links medical, community-based and behavioral health services.
The goal of Here-for-You is to improve health outcomes and reduce emergency room and acute hospital admissions. This program improves the communication and coordination between behavioral and physical health care providers to ensure patients do not fall through the cracks as they transition between different kinds of care.
In addition to funding and training care coordinators who will be employed by the community-based clinics, NHP and Beacon will also train health center staff, provide technical assistance, and make its team of registered nurses and nurse practitioners available to ensure those with serious mental issues also receive the primary care they need.
Recovery Coach Program
The Recovery Coach Program launched by MGH and supported by NHP and Beacon seeks to reduce recidivism among people with substance use disorders through a peer-to-peer connection. These individuals, who are state trained and certified, understand the barriers to recovery some substance users face because the coaches themselves are in recovery. NHP and Beacon fund a position, which is not reimbursed by MassHealth, that supports services in MGH's community health centers, downtown practices, and Everett site.
Inspired by the sponsorship model familiar to Alcoholics Anonymous and Narcotics Anonymous, the Recovery Coach Program aims to improve treatment and reduce costs by providing patients who are difficult to reach and treat with trusted advocates. These advocates will work with physicians and therapists to develop a comprehensive treatment plan and then do the necessary follow-up to ensure that patients don't regress when they are discharged from the hospital or complete a treatment program.
The recovery coaches also work with high-risk patients to resolve any legal, financial, employment, transportation, or lifestyle issues that might trigger a relapse.
|
|
Universal Neuropsychological Assessment Form
The Mass Collaborative recently developed a universal form for neuropsychological assessment prior authorization requests. This form is now available in the Forms section of nhp.org/provider. Starting May 1, 2016, all requests for neuropsychological assessments with a medical diagnosis must be submitted on this form and faxed to NHP at 617-586-1700.
|
Payment Policy Updates
The following payment policies have been revised (effective 4/1/16) and are now available on nhp.org:
- Serious Reportable Events & Provider Preventable Conditions
- Chiropractic Care
|
Medical Policy Updates The following medical policies have been revised (effective 4/1/16) and are now available on nhp.org: - Durable Medical Equipment (All Products) - New medical policy describing the describe the guidelines NHP utilizes to determine the medical appropriateness of durable medical equipment (DME).
- Mobile Cardiac Outpatient Treatment (All Products) - Annual review without substantial changes in medically necessary indicators. References updated.
- Extended Care Facility (All Products) - Annual review without substantial changes in medically necessary indicators. References updated.
- Absorbent Products for Incontinence (All Products) - Annual review without substantial changes in medically necessary indicators. References updated.
- Phototherapy & Photochemotherapy for Dermatologic Conditions (All Products) - Annual review without substantial changes in medically necessary indicators.
Click Here to view all NHP medical policies.
|
|
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
|
|
|
|
