Provider News 
Anniversary 
NHP's 30th Anniversary   
 
Throughout our 30 year history, Neighborhood Health Plan (NHP) has been a leader in implementing innovations that allow us to keep delivering on our promise of providing high-quality, affordable care to populations that need it.

In collaboration with our provider partners, the innovations where NHP has been a leader include population health management, social care management, and integrated care management. The underlying themes of today's innovations are greater coordination and integration with our provider network and care management partners. These kinds integrated care models will characterize the future of health care.

Even as we look back to celebrate our 30th anniversary, as always, we look ahead to anticipate the needs of our provider network and members. We thank you for being a valued partner in our mutual efforts to serve our members and look forward to many more years ahead! 
 
  NCC
Neighborhood Care Circle: An Innovative New Program for Critically At-Risk Members  
 
This week, NHP is launching Neighborhood Care Circle, a new clinical program to address the complex needs of critically at-risk members who account for a large percentage of emergency room visits, lengthy hospital stays, and other acute interventions that contribute to the rising cost of health care. NHP estimates that less than 1 percent of its members are responsible for as much as 20 percent of health care spending.

What makes Neighborhood Care Circle unique
  • Four multidisciplinary teams, working mostly in the communities where members live, and supported by NHP clinical specialists, will target the most vulnerable and difficult to reach members who often suffer from chronic conditions and behavioral health issues.
  • These teams will get to know our members' personal needs and find creative solutions to help them, like arranging transportation to medical appointments, to offer the right resources to help them recover and stay healthy so as to prevent costly interventions later, such as emergency room visits and hospital admissions.
  • The teams will visit members in their homes, in the hospital, in shelters or wherever else they may live.
This new program supports all NHP lines of business, including our commercial and MassHealth members. You can read more about our new program on NHP's website.

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

Register today:

Date: Thursday, June 30, 2016 (11-1 PM)  

Time: 11:30-1:00 AM

Location:   Lowell Community Health Center

161 Jackson St

CHEC Training Room (6th Floor)

Lowell, MA 01852

RSVP: Click Here    

 extension 
Reminder: Length of Stay Extension Requests 
 
As a reminder, to request an extension to the length of stay of an admission, the following steps are required:

Step 1) The request for additional days must be submitted through HealthTrio as a revision to the existing authorization. Faxed requests will not be accepted.

Step 2) Once the extension request has been submitted through HealthTrio, additional clinical notes are required for review. For the fasted review turnaround, NHP recommends that additional notes be uploaded directly to the authorization in HealthTrio. If you cannot upload clinical notes to HealthTrio, additional clinical notes can be faxed to 617-586-1700. Faxed clinical notes should include the authorization number on the fax cover page.

For detailed information on how to request an extension and upload clinical notes, Click Here to access the HealthTrio User Guide. 
assembly 
NHP is Moving to Assembly Row in 2017   
  
In 2017, NHP will move to a new location in Assembly Row, Somerville. The move is economically and environmentally efficient, consolidating 14 separate locations into one "green" building.  

We are excited to move into a sustainable and modern work environment. Modeled on a "healthy design" concept, our new building's features include a Leadership in Energy and Environmental Design (LEED) certification-a green building certification program for design that promotes a positive impact on the health of occupants, and renewable and clean energy. The building's open space concept will help us to further facilitate collaboration and connectivity.

We will provide you with more information in the fall.

PCPassignment 
Reminder: Primary Care Provider Assignment Changes   
 
In our continuing efforts towards administrative simplification and data integrity, effective June 1, 2016, Primary Care Provider's (PCPs) can only update their NHP patients' PCP assignment via NHPNet. Faxed PCP assignment change requests will no longer be processed. 

The following NHPNet enhancements are now available:
  • PCP office staff can now reassign members to a closed panel PCP within their group practice
  • PCPs can now add NHP patients to their panel from another PCP panel outside their group practice. To complete this transaction, you will be required to attest to obtaining member consent.
As a reminder, members can update their PCP assignment via the member portal (MyNHP.org) or by calling Customer Service.

 Code 
Coding Update: G0402-G0405 Not Covered  
 
Effective August 1, 2016, the following codes that pertain to the initial services for Medicare Enrollment will deny for non-coverage (NHP is not a Medicare plan):

Code
Description
G0402 Initial preventative physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment
G0403
Electrocardiogram, routine ECG with 12 leads; performed as a screening for the initial preventative physical examination with interpretation and report
G0404
Electrocardiogram, routine ECG with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventative physical examination
G0405
Electrocardiogram, routine ECG with 12 leads; interpretation and report only, performed as a screening for the initial preventative physical examination

 

NHP does cover medically necessary diagnostic services including ECGs, which may be billed with appropriate CPT codes. NHP covers well visits, which may be billed with appropriate CPT codes.  

Fee 
2016 Fee Schedules 
  
Over the next few months, standard professional fee schedules will reflect 2016 Relative Value Units (RVU) and codes added, revised, or deleted by CMS and the American Medical Association (AMA). 

  MPR
Medical Policy Updates 
 
The following medical policies have been revised and are now available on nhp.org:
  • Qualified Medically Supervised Weight Management Programs (All Products) - effective 6/1/16
    • Revised name of policy (formerly "Medically Supervised Weight Management")
    • Revised criteria language for clarity
    • Added to exclusions:
      • Dietary food/supplements
      • Providers not in NHP Network
    • Added nutritional counseling definition to align with payment policy
  • Outpatient Drug Screening and Testing (All Products) - effective 7/1/16 - New medical policy describing the guideline NHP uses to determine the medical appropriateness for drug testing

Click Here to view all medical policies. 

 Chir  
Reminder: 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.


Thank You! 

 

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