Authorization & Referral System Enhancements Now Available
NHP is dedicated to ensuring an optimal provider experience when requesting authorizations and referrals. To support this effort, NHP recently launched several enhancements to our authorization and referral intake system. These enhancements will result in a more streamlined submission process and improved authorization/claim matching functionality. Refresh Your Web BrowserTo enable all functionalities in NHPNet, you must refresh your browser by pressing CTRL+F5. You can also change your Internet Explorer settings to refresh automatically each time you log in. Click Here for step-by-step instructions. Updated User GuidesClick Here to access the updated user guides with step-by-step instructions on how to enter or revise requests. Register for a Webinar Training
Additional webinars have been scheduled in October to review the new features. Please click on the link corresponding to the session you would like to attend:
Admission (acute inpatient, chemotherapy, obstetric, sick newborn, surgical, transplants, etc)
Monday October 10, 2016 11:30-12:30 PM
Outpatient (DME, observation, occupational/physical therapy, speech therapy, etc)
Tuesday October 18, 2016 12:00-1:00 PM
Specialist Referral
Thursday October 20 11:30-12:30 PM
Home Health Care
Tuesday October 11, 2016 11:30-12:30 PM
Questions?
Please email all NHPNet access and authorization/referral submission process inquiries to NHP Provider Services at prweb@nhp.org. You can also call Provider Services at 1-855-444-4647. We are available Monday through Friday from 8:00 AM to 6:00 PM.
|
Regional Provider Meeting at Lowell Community Health Center
NHP Provider Relations is hosting a series of regional provider meetings across Massachusetts to discuss the latest news and updates. Topics will include: authorization and referral system enhancements, an overview of new programs such as Neighborhood Care Circle, an update to new utilization management requirements, and much more. The next regional provider meeting will be held at Lowell Community Health Center on October 21, 2016. Register Today:
Date: Friday October 21, 2016
Time: 11:30 AM - 1:00 PM
Location: Lowell Community Health Center
161 Jackson Street
Community Health Education Center (CHEC), 6th floor
|
New Imaging Services and Medication Standardized Prior Authorization Forms
The Mass Collaborative, which includes NHP along with other health plans, clinicians, and hospitals, recently developed three standardized prior authorization forms for imaging services and one standardized prior authorization form for prescription drugs requests (excluding hepatitis C treatments and Synagis):
- Medications
- Cardiac Imaging (Myocardial Perfusion Imaging "MPI", Stress Echocardiogram, Multiple Gated Acquisition Scan "MUGA", Transthoracic Echocardiogram "TTE", and Transesophageal Echocardiogram")
- PET - PET CT
- CT/CTA/MRI/MRA
Click Here to access the standardized imaging forms. Click Here to access standardized medications form. Submitting Imaging Services Prior Authorization Forms to eviCore NHP is partnering with eviCore Healthcare for utilization management of imaging services. Completed imaging prior authorization forms should be faxed to eviCore at 888-693-3210
Submitting Pharmacy Prior Authorization Forms to CVS/caremark
NHP is partnering with CVS/caremark for utilization management of medication prior authorization requests. Completed medication prior authorization forms should be faxed to CVS/caremark at:
- Non-Specialty Drug Request Fax Number
- MassHealth: 866-255-7569
- Commercial: 888-836-0730
- Qualified Health Plan: 855-245-2134
- Specialty Drug Request Fax Number
- All Products: 866-249-6155
|
NCQA Rates NHP Commercial HMO Plans and Medicaid Plans with 4.5 Stars!
The National Committee for Quality Assurance (NCQA) recently released their annual health plan ratings for 2016-2017. These ratings measure health plans across the nation on clinical quality and member satisfaction. We are proud to share that NHP's commercial HMO plans received a performance rating of 4.5 stars, placing NHP among the nation's highest rated commercial plans. These results speak to NHP's continued growth and success in the commercial market, and our commitment to high-quality services.
NHP's Medicaid line of business also received a 4.5 star rating, again placing NHP among the nation's highest rated Medicaid plans.
|
Provider Network Satisfaction Survey
Thank you for participating in the 2016 provider network satisfaction survey and ranking NHP as the overall easiest health plan to work with! We are proud of this achievement and dedicated to our continuous efforts to improve the way you do business with NHP.
Your feedback is appreciated and will help us look for ways to better serve our providers. For example, many providers have indicated that NHP's website and online resources are easy to use and navigate, and they would like to continue to see new functionalities available to support the provider experience. We hope to achieve this with upcoming enhancements such as the recent improvements to NHP's authorization and referral intake system.
Congratulations to Susan Montgomery of New England Baptist Hospital for winning a Kindle Fire!
Have additional feedback?
Click Here and share your thoughts
|
Non-Covered Services
As a reminder, NHP does not cover or otherwise reimburse for experimental/investigational services or for services excluded from benefit coverage. Non-covered services include, but are not limited to, the following:
Effective for dates of service on or after December 1, 2016, the following service will be considered experimental/investigational and non-covered by NHP:
- 86357 - Natural Killer (NK) Cells, Total Count
Additional non-covered services include, but are not limited to, the following: | Acupressure | Impact Resistant Lenses | | Car Lumbar Support( Pads) | Integrative Medicine Consults | | Cast Covers | iWALK Crutches | | Cefaly Device | Knee Walker | | Coccyx Cushion | Lice Clinic of America | | Cold Caps and Cold Cap Systems | Marsupial Pouch | | Corus Coronary Artery Disease (CAD) Gene Expression Test | Massage Therapy (Spa) | | Craniosacral Therapy | MySentry by MedTronics. | | Elevators & Lifts to the Home | Nail Fungus Laser Surgery | | Fischer Wallace Stimulator | Pulsed Radiofrequency (RF) Ablation | | GeneSight Testing | Service Dogs | | Hair Follice Toxic Element Exposure Profile Test | External Shock Wave Therapy (ESWT) for Foot Conditions | | High Energy Shock Wave Therapy | Speech Therapy Tool Speech Buddies | | Home Births | Toilet Stool (Squatty potty) | | Homeopathic Sports Therapy | |
|
NHP MassHealth Fee Schedule Reminder
In June, NHP shared plans to update our 2016 fee schedules to reflect current industry guidelines. As a reminder, NHP's MassHealth line of business (NHP Connect) aligns the reimbursement of codes with MassHealth guidelines. With the implementation of planned fee schedule updates, codes that are not payable under MassHealth guidelines will be removed. MassHealth's code reimbursement guidelines can be found in MassHealth's Provider Manuals. To ensure appropriate billing and reimbursement, please review the MassHealth code listings and use codes identified as payable.
|
Virtus Pharmaceuticals Issues a Voluntary Recall of Hyoscyamine Sulfate 0.125 mg tablets
On September 15, 2016, Virtus Pharmaceuticals issued a voluntary recall of hyoscyamine sulfate 0.125 mg tablets. They issued this recall because the dosage could be superpotent or subpotent.
Virtus Pharmaceuticals will refund patients' out-of-pocket costs for this prescription. To receive a refund, patients have two options:
- Return their tablets to the place of purchase for an immediate, on-site refund
- Call Virtus Pharmaceuticals at 855-255-6076 to request a return/refund kit
For additional information about this recall please call Virtus Pharmaceuticals at 855-255-6076, Monday through Friday, 8:00 am to 5:00 pm, or visit virtusrx.com. You can also contact the FDA consumer inquiry line at 1-888-INFO-FDA (1-888-463-6332) or visit www.fda.gov.
|
Baystate Mary Lane Outpatient Center Joins NHP's Network
On September 10, 2016, Baystate Mary Lane Hospital merged with Baystate Wing Hospital. As a result of this transition, Baystate Mary Lane Hospital has been renamed Baystate Mary Lane Outpatient Center and has joined NHP's network. Baystate Mary Lane Outpatient Center will continue to offer the same outpatient services and emergency medical care, however the facility will no longer offer inpatient services. Patients needing inpatient care can receive this service at nearby inpatient facilities.
|
Accordant's Influenza Campaign
NHP partners with Accordant for care management of patients with complex, chronic conditions. In November, Accordant will be starting their influenza campaign to encourage enrolled patients in one of their programs to talk to their primary care provider about the flu vaccination. As part of this campaign, PCPs with members in an Accordant program will have the option to receive a report of patient self-reported flu vaccine status information. Accordant will provide you with more information on how to request this report in an upcoming mailing.
|
MassHealth MCO Plan Selection and Fixed Enrollment Periods
As a reminder, MassHealth implemented Plan Selection Periods and Fixed Enrollment Periods on October 1, 2016:
Plan Selection Period (October 1-December 31) - Members enrolled with an MCO will only be able to change MCOs during their annual 90-day Plan Selection Period.
Fixed Enrollment Period (January 1-September 30) - Once the 90-day Plan Selection Period has ended, members will be in a Fixed Enrollment Period and, except in limited circumstances, members will be unable to change MCOs until their next annual Plan Selection Period.
|
Serious Reportable Events & Provider Preventable Conditions
As required by the Massachusetts Executive Office of Health and Human Services (EOHHS), providers must report provider preventable conditions to NHP. The Serious Reportable Events & Provider Preventable Conditions payment policy guideline outlines this requirement and that NHP will not pay the provider for any covered service that constitutes a provider preventable condition. Click Here to access the Serious Reportable Events & Provider Preventable Conditions payment policy guideline.
|
Medical Policy Updates
The following medical policy updates include:
- Reconstructive and Cosmetic Procedures (All Products) - effective 10/1/16 - Annual review without substantial changes in medically necessary indicators. References updated.
- Home Health Care (All Products) - effective 10/1/16 -Clarification to the definition of homebound. Clarification to exclusions.
- Bone Growth Stimulator (All Products) - effective 10/1/16 - Annual review without substantial changes in medically necessary indicators. References updated.
Click Here to view all medical policies.
|
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
|
|
|
|
|
