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! 

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.

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    

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. 

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.

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). 

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.