Dr. Paul Mendis Appointed to the Special Commission to Examine the Feasibility of Establishing a Pain Management Access Program
On June 30, 2016, the Baker-Polito administration announced appointees to three special commissions created under the landmark opioid legislation signed into law earlier this year. Dr. Paul Mendis, Chief Medical Officer, was named to the Special Commission to Examine the Feasibility of Establishing a Pain Management Access Program. This commission will analyze the potential usefulness of the Commonwealth establishing a pain management program in order to increase access to pain management services. Click Here to find out more.
|
You Are Invited: Post-Acute Care Authorization Webinar
NHP Provider Relations and Clinical staff are hosting a webinar training to review the authorization submission process for post-acute care. To attend this webinar, RSVP by clicking on the link below. Date: July 7, 2016 Time: 11am -12pm RSVP: Click Here
|
We're Going Green! The Clinician Quarterly Updates Will Now Be Available in the Provider e-Newsletter
The Clinician Quarterly newsletter includes clinical updates and is mailed out to our provider network. Our next issue of the Clinician Quarterly will be our last. From now on, our clinical information and updates will be included in the monthly provider e-newsletter. To sign-up for the monthly e-newsletter, please share this registration link with your staff: www.nhp.org/providernews.
|
Technology Update
NHP's Marilyn A. Daly, CIO Named Chief Information Officer of the Year
Marilyn A. Daly, who has led technology efforts at Neighborhood Health Plan (NHP) for the past 12 years, was named "Chief Information Officer of the Year" by the Boston CIO Leadership Association. The award recognizes top innovators in a variety of sectors "who keep their companies running ahead of the curve."
Daly won in the non-profit category for her accomplishments integrating information technology with NHP's business operations on behalf of customers. For example, in collaboration with providers and other NHP departments, Daly developed an informational "dashboard" that allows doctors and hospitals to improve care by giving clinicians real time data on both the treatment histories of individual patients and the health characteristics of whole populations.
Click Here to read the full press release.
Authorization and Referral Submission Enhancements to Go-Live on September 1NHP is dedicated to ensuring an optimal provider experience when requesting authorizations and referrals. To support this effort, NHP is launching several enhancements to our authorization and referral intake system on September 1, 2016. These enhancements will result in a more streamlined submission process, and improve authorization/claim matching functionality. As part of the transition, NHP will be conducting several provider trainings starting in August to support your staff. We will send you additional information in the next few weeks.
|
New UM Programs: Resources and Provider Orientations
Effective August 1, 2016, NHP will partner with eviCore Healthcare to implement the following utilization management programs:
- Non OB-Ultrasounds
- Selected Cardiac Imaging & Diagnostic Services
- Selected Molecular & Genetic Testing
- Radiation Therapy
Provider Orientations Provider orientations have been scheduled and will cover the following topics: program overview, provider portal registration, and the prior authorization process. To register for and participate in a session: - Go to http://medsolutions.webex.com/
- Click on the "Training Center" tab at the top of the Web page
- Find the date and time of the conference you wish to attend by clicking the "Upcoming" tab. All of the Provider Orientation Sessions will be named "Neighborhood Health Plan Orientation Session"
- Click "Register"
- Enter the registration information
After you have registered for the conference, you will receive a confirmation e-mail. Please keep the registration e-mail so you will have the link to the Web conference an Implementation SiteAn implementation site has been set up to centralize available resources, such as: information on how to register for eviCore's provider portal, CPT codes that require prior authorization, and clinical guidelines. You can access the implementation site at: http://www.medsolutions.com/implementation/NHP/.
|
Promoting Health and Wellness with the Red Sox Foundation
NHP is the first health plan to sponsor the Red Sox Foundation's Reviving Baseball in Inner Cities (RBI) Program, which uses team sports to reduce youth violence, inspire academic success, promote healthy choices and develop useful life skills. The Foundation's RBI Program and its companion Rookie League annually reach a 79 percent diverse population of 2,000 children and teens between the ages of 5 and 18 in 13 neighborhoods in Boston. Dr. Paul Mendis, Chief Medical Officer, recently sat down with NESN to discuss our partnership with the Red Sox foundation and support of the RBI Program. Click Here to watch the video.
|
Neighborhood Care Circle: An Innovative New Program for Critically At-Risk Members
NHP recently launched 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. Click Here to find out more about Neighborhood Care Circle.
|
Medical Policy Updates
The following medical policies have been revised and are now available on nhp.org:
- Insulin Pumps (All Products) - effective 7/1/16 - Annual review without substantial changes in medically necessary indicators. References updated.
- Preimplantation Genetic Testing (All Products) - effective 7/1/16 - Annual review without substantial changes in medically necessary indicators. References updated.
- Continuous Glucose Monitors (All Products) - effective 7/1/16 - Annual review without substantial changes in medically necessary indicators. References updated.
- Prostheses - Lower Limb (All Products) - effective 7/1/16 - New medical policy describing the guidelines NHP uses to determine the medical appropriateness of lower limb prostheses.
- Prostheses - Upper Limb (All Products) - effective 7/1/16 - New medical policy describing the guidelines NHP uses to determine the medical appropriateness of upper limb prostheses.
Click Here to view all medical policies.
|
Reminder: Urine Drug Testing
Effective July, 1, 2016, NHP has updated the urine drug testing payment policy and published a drug testing medical policy. The updated policies reflect the following changes which apply to outpatient urine drug testing:
- NHP will reimburse presumptive drug class screenings HCPCS G0477-G0483 for medically necessary urine drug testing services
- NHP will reimburse one unit per date of service or per day for HCPCS G0477-G0483 as described in the code narratives
- NHP will no longer reimburse CPT 80300-80304
- Submission of documentation will be required when billing more than 20 tests within a benefit period as described in the medical policy
You can access the urine drug testing payment policy at: https://www.nhp.org/provider/doingbusiness/Pages/Payment-Policies.aspx
You can access the drug testing medical policy at: https://www.nhp.org/provider/clinical/Pages/Medical-Policies.aspx
|
|
Hospital Inpatient Utilization Report
The latest quarterly hospital inpatient utilization 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.
|
|
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
|
|
|
|
