Posted on December 3, 2025
As a reminder, some of our Medicaid/BeHealthy Partnership members may be limited in English proficiency and, by law, have rights mandated by the Commonwealth of Massachusetts under the Limited English Proficiency laws. If you are caring for one of our Medicaid members, MassHealth regulations requires you to provide interpreter services so the member can receive […]
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 July 2, 2024
Health New England’s formularies are located at healthnewengland.org. At the top of the page, use the “Find A Drug” tool. Prescription Drug Coverage- Commercial Note: Tier 1 – lowest copay level; Tier 2 – mid copay level; Tier 3 – highest copay level For 5-tier formulary- Tier 4-lowest specialty tier; Tier 5-highest specialty tier Step […]
Posted on July 2, 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. Discarded Drugs & Biologicals Effective 6/1/2024 Reviewed with no changes Evaluation & Management Professional Services Effective 6/1/2024 Removal of expired codes […]
Posted on June 4, 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. Vaccines & Immunizations Effective 5/1/2024 Added Industry Standard Language Added additional language to Non-State Supplied Vaccines under Commercial Conditional Formatting Inpatient […]
Posted on June 4, 2024
Health New England’s formularies are located at healthnewengland.org. At the top of the page, use the “Find A Drug” tool. Brand Name Generic Name GPI Commercial Formulary status Aphexda MRX MOTIXAFORTIDE ACETATE 82502050102150 PA thru Magellan, T4 Daxxify MRX DAXIBOTULINUMTOXINA-LANM 90890045402140 PA thru Magellan, T4 Elrexfio MRX ELRANATAMAB-BCMM 213520281520** PA thru Magellan, T4 Eylea […]
Posted on June 4, 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. Nutritional counseling No changes. Lymphedema- Surgical Treatment No changes. Blepharoplasty and Browplasty No changes. Cosmetic and Reconstructive Procedures Criteria in section E4 clarified; no other […]
Posted on June 1, 2024
The mission of Health New England is to improve the health and lives of the people in our communities, and we are deeply committed to those individuals we serve every day. In addition, we believe everyone must have the opportunity to attain their full health potential with no disadvantage due to social or socially assigned […]
Posted on June 5, 2023
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. The following policies were reviewed with no substantial changes and were moved into our new template. Dental Anesthesia – New policy to document the procedure that Health New […]
Posted on June 5, 2023
Health New England reviews our formulary and makes necessary changes. Health New England’s formularies are located at healthnewengland.org. At the top of the page, use the “Find A Drug” tool. For more information, please do not hesitate to call your Provider Relations Representative at (800) 842-4464, extension 5000, or send an email to providerrelations@hne.com.