Posted on December 1, 2023
The Qualified Medicare Beneficiary (QMB) Program is one of the four Medicare Savings Programs that allows Enrollees to get help from the state to pay Medicare premiums and cost sharing. Some Health New England Medicare Advantage members have this benefit, and the Federal law prohibits Medicare providers from collecting coinsurance, copayments and deductibles from those […]
Posted on December 1, 2023
Attention Providers and Practice Managers: Accurate provider directories are critical to helping our members make educated decisions about their plan choices. Health New England offers an online directory for all products, and hard copies of each directory are available upon request. In an effort to support the Centers for Medicare & Medicaid Services (CMS), MassHealth, […]
Posted on December 1, 2023
Effective immediately, Health New England (HNE) will begin waiving pre-admission screening of individuals, in all lines of business, seeking admission to skilled nursing facilities (SNF), after normal business hours on Friday through Sunday; Monday, if legal holiday. HNE does require notification of the SNF admission within 48 hours, as well as the anticipated discharge date […]
Posted on December 1, 2023
It is Health New England’s (“HNE”) policy to conduct its business in compliance with all applicable federal and state laws and regulations and to assure that HNE operates in a manner consistent with the letter and the spirit of the laws. This Code of Conduct applies to all HNE employees and associates, including members of […]
Posted on November 15, 2023
Upgrade to our Core Claims Platform Friday, November 17, through Sunday, November 19, 2023 As part of our continuing commitment to operational improvement, we will be undergoing an upgrade to our Core Claims platform the weekend of Friday, November 17, through Sunday, November 19. As part of this process, all 837 claims files received after […]
Posted on November 1, 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. Cosmetic and Reconstructive Procedures: Coding guidance updated. CPT 15847 not covered for all lines of business. Knee Braces: Clarification HNE’s policy is retired as of 11/1. Please […]
Posted on November 1, 2023
Health New England reviews our benefit plans each year. The below outlines the upcoming changes our Members are seeing during open enrollment. Each plan year has an effective plan date of January 1, 2024. Medicare Advantage: Health New England is closing the Choice (HMO) plan effective 12/31/2023. In addition, below are some copay changes and […]
Posted on November 1, 2023
Back in 2021, with the release of the Division of Insurance Bulletin 2021-09, Health New England aligned our systems to look for the appropriate service codes and diagnosis related to PrEP (Pre-exposure prophylaxis) and respond as preventative care. Once again, with the release of the new ICD diagnosis code Z29.81, we have added it to […]
Posted on November 1, 2023
Health New England has shared, since 2017, our hopes of going paperless and providing all notices, including 60-day change notices electronically. Effective 12/1/2023, Health New England will no longer print and mail the ProviderMatters communications. On this date, you can locate the notices on our public site at http://hnetalk.com/provider/home. Using the search button, you can […]
Posted on November 1, 2023
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, visit healthnewengland.org/Providers/Resources. The following policies were reviewed and updated: Urgent, extended care & walk-in care – reviewed against authorization process Skilled nursing facility […]