Posted on November 11, 2024
Effective January 1, 2025, the management of Health New England radiology and cardiology prior authorizations through eviCore will transition from the MedSolutions portal platform to the CareCore National portal platform. While this change will have minimal impact on providers, the steps to submit authorizations requests through the portal will slightly change. To prepare, we invite […]
Posted on November 11, 2024
The QMB eligibility group is a Medicaid eligibility group through which states pay Medicare premiums and cost sharing for certain low-income Medicare beneficiaries. Since 1997, federal law has prohibited Medicare providers from collecting Medicare Part A and Part B coinsurance, copayments, and deductibles from QMBs, including those enrolled in Medicare Advantage and other Part C […]
Posted on November 11, 2024
New: Virta Health Nutritional Therapy Program Effective October 1, 2024, Health New England began partnering with Virta Health on a new Nutritional Therapy for Weight Loss and Diabetes Reversal Program, offered at no cost to eligible members.* Virta’s program is available for eligible Medicare Advantage members and fully funded Commercial members and their covered dependents […]
Posted on November 11, 2024
Health New England is committed to reviewing our internal procedures and define coverage and billing guidelines with applicable laws and industry standards to ensure our policies are appropriate. To access payment policies, please visit healthnewengland.org/Providers/Resources. The following policies were reviewed and updated: Policy Effective Date Summary of Changes Laboratory Professional Services Effective 10/1/2024 Update the panel […]
Posted on November 11, 2024
Treatment for Varicose Veins and Venous Insufficiency Annual Review InterQual criteria adopted for commercial lines of business. CPT 36482 and 36483 status changed from non-covered to covered with PA for commercial line of business. CPT code 36473 and 36734 changed from non-covered to covered with PA for commercial line of business. InterQual to be followed […]
Posted on November 11, 2024
Health New England reviews clinical policies and updates accordingly. These policies reside at healthnewengland.org/Providers/Resources. Once on the Resources page, click on Behavioral Health/Medical Policies to learn more. Cochlear Implant Annual Review, effective 12/1/2024. All lines of business transitioned to InterQual with the exception of guidelines for MassHealth or Medicare. Speech Therapy for Autism […]
Posted on October 8, 2024
Health New England reviews clinical policies and updates accordingly. These policies reside at healthnewengland.org/Providers/Resources. Once on the Resources page, click on Behavioral Health/Medical Policies to learn more. CAR-T Therapy Effective 10/1/2024 CAR-T therapies will be reviewed by Prime Therapeutics (formerly Magellan Rx) for Commercial and Medicare Advantage lines of business. Health New England will continue […]
Posted on October 8, 2024
Health New England is committed to reviewing our internal procedures and defining coverage and billing guidelines with applicable laws and industry standards to ensure our policies are appropriate. To access payment policies, please visit healthnewengland.org/Providers/Resources. The following policies were reviewed and updated: Policy Effective Date Summary of Changes Individual Consideration Services 10/1/2024 Removed bullet on additional […]
Posted on September 9, 2024
Health New England reviews clinical policies and updates accordingly. These policies reside at healthnewengland.org/Providers/Resources. Once on the Resources page, click on Behavioral Health/Medical Policies to learn more. We reviewed the following policies with no substantial changes. We either moved the content into our new template or retired the policy. Musculoskeletal Surgery: Arthroplasty (Notification of Effective […]
Posted on September 9, 2024
Unlisted Procedures & Services: Billing & Documentation Requirements Section Added block for Anesthesia Services Unlisted coded within the range of 00100 – 01999 along with documentation requirements. Medical Health Policies: Non-Emergent Transportation Effective 11/2/2024 Medicaid/BeHealthy transportation is directly covered by MassHealth – policy does not apply. For Medicare Advantage, will continue to follow guidance […]