Posted on April 7, 2025
Updates Notes MassHealth All CAR-T drugs transition to the MassHealth Drug Utilization Review (DUR) Program Effective April 1, 2025, MassHealth will transition the review and management of all CAR-T drugs to the MassHealth Drug Utilization Review (DUR) Program. Health New England will continue to review all other services related to CAR-T. The Chimeric Antigen […]
Posted on April 7, 2025
Please read the following update related to various Health New England programs and changes that may have an impact on your patients and/or your practice. 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 […]
Posted on March 7, 2025
Please read the following update related to various Health New England programs and changes that may have an impact on your patients and/or your practice. 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 […]
Posted on February 7, 2025
Please read the following update related to various Health New England programs and changes that may have an impact on your patients and/or your practice. 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 […]
Posted on January 6, 2025
Please read the following update related to various Health New England programs and changes that may have an impact on your patients and/or your practice. Policy Review Notes Updates Peripherally Implanted Nerve Stimulation (PNS), Peripheral Subcutaneous Field Stimulation (PSFS) policy to be retired effective 3/1/2025. CPT codes 64555, 64596, and 64598 will be experimental […]
Posted on December 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. Policy Review Notes Update Breast Surgery Policy updated to add Z85.3 to the list of ICD-10 codes for Breast Cancer; effective 11/1/2024. Medical Policies PANS/PANDAS Annual Review with […]
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 […]