Take NHP's Provider Directory Survey For a Chance to Win a Kindle Fire!
NHP is performing an annual assessment of the accuracy of data in our provider directory. Incorrect data contribute to patient dissatisfaction and can result in claims payment problems. In order to better support our members and providers, we ask that you verify that your directory entry is complete and correct. Completed submissions will be entered into a raffle for an Amazon Kindle Fire! To begin, please click here to access the provider directory and locate your own listing. Please select any plan option in the "Choose Plan" field, then type your practice name and location in the appropriate fields that follow. Once you have found your directory listing, please answer the six questions in this survey or copy and paste the following link to your web browser:
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NHP Medicaid Updates
NHP Names Paulette Shaw Querner to New Post of Chief Medicaid Officer
NHP has a proud history of offering MassHealth coverage and high-quality access to care. To support the commitment to our mission and to the MassHealth program, NHP recently named Paulette Shaw Querner to the newly-created position of Chief Medicaid Officer. Querner will provide innovative and strategic leadership in her role, guiding the evolution of NHP's core Medicaid business and providing oversight of the development of Accountable Care Organization partnerships critical in creating a sustainable and economically viable MassHealth program with better clinical outcomes for patients.
NHP and MassHealth Begin a Temporary Enrollment Freeze of New MassHealth Members Joining NHP
Click Here to read the provider notification.
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2017 MA Health Connector Open Enrollment
From November 1, 2016 through January 31, 2017, Massachusetts Health Connector members can begin shopping for their 2017 health care coverage. For health plan enrollment support, your patients can contact the Health Connector at 1-877-623-6765.
As a reminder, patient health plan coverage you have on file can change. To ensure you have the latest coverage information, please remember to use NHPNet to verify member eligibility and that the appropriate referrals/authorizations are in place prior to rendering services.
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Treating Patients with Depression Using Coordinated Medication Management
Neighborhood Health Plan (NHP) and Beacon Health Options (Beacon) are offering an online training on treating patients with Depression.
We encourage you to participate in this online training which provides a comprehensive overview of the condition, diagnostic tools, best practices for care, and the support and resources provided to you by NHP and Beacon. During this free, two-part training, you will learn about the elements of Depression as well as a proven approach for successful diagnosis. Furthermore, we will review how NHP and Beacon can support you in serving your patients with this diagnosis.
Learning Objectives Upon completion of the training, participants should be able to:- Improve the accuracy of diagnosing depression
- Optimize the use of depression screening tools
- Identify four medical mimics of depression
- Understand the value of and access to the Psychotropic Drug Intervention Program (PDIP) & Antidepressant Medication Management (AMM)
- Optimize medication treatment of depression
Registration Instructions
PROCEDURE
Complete these steps to register and complete the course.
- Go to https://www.coursesites.com/s/_amm
- Select Self Enroll.
- If needed create an account to register.
Registration:
Your will need to add your name, email address, and country.
You will be asked to select a username and password also.
Note: You will use this to access the online courses.
Accessing the course:
Once your account is created, you can navigate to the course, located on the left side of the screen.
Click the Training link to begin.
There are two (2) modules that you can complete.
Note: When you launch the module, the video begins automatically
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PCP Behavioral Health Screening
Standardized behavioral health screening tools are effective in identifying children with behavioral health problems. As a reminder, NHP will reimburse PCPs who offer standardized and age-appropriate screening tools at all well-child visits for Commercial and MassHealth members under the age of 21 (up to 1 unit per patient per day). Reimbursement for the screening tool is in addition to the reimbursement for the well-child visit.
How to submit claims Use service code 96110 (Developmental testing: limited) with the appropriate "U" modifier:
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Benefit Updates and Reminders
HIV-Associated Lipodystrophy In August, Governor Charlie Baker signed a new Massachusetts law requiring insurers to cover medical or drug treatments to correct or repair disturbances of body composition caused by HIV associated lipodystrophy. A new medical policy is now available outlining NHP's policy for medical appropriateness for treatment of HIV-Associated lipodystrophy syndrome.
Orthotics As a reminder, NHP Commercial plans limit the orthotic benefit to only members up to age 15 years. This is not a covered benefit for Commercial members 16 years of age and older. For NHP MassHealth members, the orthotics benefit will align with the MassHealth published quantify limits and prior authorization is required.
Preventative Tuberculosis Screening Preventative tuberculosis (TB) screening is currently covered for children' up to age 21. Effective January 1, 2017, the age restriction will be removed for preventative TB screening to align with industry standards. You may bill with code 86580 or 86480 (append modifier 33 when using either code).
Medication Assisted Treatments for Opioids Effective January 1, 2017, Medication assisted treatments for opioids will be covered with no cost for NHP ConnectorCare plans. Use a diagnosis of opioid related disorders (F11.10-F11.99) and append modifier HF to an E&M code (99201-99205, 99211-99215).
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NHP Is Moving to Assembly Row, Somerville
As a reminder, NHP will move to a new location in Assembly Row, Somerville in January. Our new corporate address will be:
399 Revolution Drive, Suite 810 Somerville, MA 02145
In the coming weeks, we will provide you with an update with additional information.
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Opdivo (nivolumab) Will Require Prior Authorization Starting 12/15/16
In order to align with industry standards for safety, efficacy, and cost-effectiveness, NHP will require prior authorization for Opdivo (nivolumab) starting on December 15, 2016.
To request prior authorization, complete the standardized form and fax it to NHP at 617-586-1700. You can find the standardized authorization form on nhp.org/providerforms.
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NHP to Implement DRG and EAPG Payment Methodologies in 2017
To align with industry practice, NHP will look to begin implementation of industry standard DRG and EAPG payment methodologies in 2017. We will provide more information over the next several months.
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Medical Policy Updates
The following are medical policy updates effective 11/1/16:
- Infertility Services (All Products) - Annual review without substantial changes in medically necessary indicators. References updated.
- Gender Reassignment Surgery (All Products) - Annual review without substantial changes in medically necessary indicators. References updated.
- HIV Associated Lipodystrophy Syndrome (All Products) - New medical policy to describe NHP's policy for medical appropriateness for treatment of HIV-associated lipodystrophy syndrome.
- Chiropractor Services (All Products) - New medical policy to describe the guidelines NHP uses to determine medical appropriateness for chiropractor services as a treatment for neuromuscularskeletal conditions.
Click Here to view all medical policies.
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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
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