Clinical Review Criteria (September 2024)
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 Date Change)
- Effective 10/1/2024
- Name changed from Total Ankle Replacement to Musculoskeletal Surgery: Arthroplasty
- Added criteria and codes for shoulder, hip and knee joint replacement, and revision: ankle joint replacement.
- References updated.
New Medical & Behavioral Health Policies:
- Home Health Care Services – Medicaid
- New Policy effective 10/1/2024 (previously included with Commercial and Medicare Advantage LOB policy).
Transportation Services
- Effective 10/1/2024
- Indications for Coverage Section
- Under HNE’s Non-Emergency Transportation Services Benefit:
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- Added language stating a non-emergent transport that will have mileage 150+ miles will require prior authorization
If you have any questions about the information in this notice, please contact Health New England Provider Experience at (800) 842-4464, extension 5000. A representative is available Monday through Friday between the hours of 8:00 a.m. and 5:00 p.m. You may also send an email to providerrelations@hne.com.
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