Formulary Update
Posted on June 29, 2022
Health New England’s formularies are located at healthnewengland.org. At the top of the page, use the “Find A Drug” tool.
ProviderMatters
Clinical Review Criteria
Posted on June 29, 2022
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.
Provider Directory: Important Reminder
Posted on June 29, 2022
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, […]
Provider Manual Update
Posted on June 29, 2022
Health New England reviews our provider manual regularly and notifies you when there are updates. Most recently, we updated the Claim Submission and Reimbursement section. Go to http://healthnewengland.org/providers/provider-manual/billing-reimbursement. We clarified the requirements of replacing and voiding your original claim. This is to ensure your corrected claim does not deny for duplications.
Preventive Services Update
Posted on June 29, 2022
Under the Affordable Care Act, Health New England must provide coverage for preventive services to our Commercial members. Preventive services are health services necessary for our members to maintain their health and well-being, and include services like routine physical exams or immunizations, screening, and certain pediatric and prenatal services. To learn more about what services […]
Companion Guide: Updated to Include Medicaid as Needing a Taxonomy
Posted on June 29, 2022
We updated our 837 5010 Claims Companion Guide to include Medicaid as another line of business that may require the taxonomy. Go to healthnewengland.org/Providers/Resources, click HIPAA Transactions, click 837 5010 Claims Companion Guide. Please see General Taxonomy Requirements on page 3 of 9. For any additional questions, please call your Provider Relations Representative at (800) […]
Important Information Regarding Ordering Durable Medical Equipment (DME)
Posted on June 29, 2022
Health New England partners with Northwood, Inc., our durable equipment benefit manager for authorizations. This includes the management of durable medical equipment (DME), medical supplies, prosthetic and orthotic for all our members. It is important to know that timely and complete submission of clinical documentation to support medical necessity is key to receiving faster responses […]
Drug Testing Policy Reminder
Posted on May 28, 2022
As a reminder, our Drug Testing Medical and Payment Policy clearly states up to 20 services for drug testing related to any diagnosis category per member per 365 days (emergency room, ambulatory surgery and inpatient services are excluded). In addition, one unit of multi-drug screenings per day except when performed as part of an emergency […]
Claims Editing Rules
Posted on May 28, 2022
As a reminder, Health New England implements National Coverage Determinations (NCD) and Local Coverage Determinations (LCD) to align our claims payment system against accepted industry rules and coding guidelines. The following edit rules will be in place May 2022: Urine Culture, Bacterial (190.12) – Effective May 23, 2022 Prothrombin Time (PT) (190.17) – Effective May […]
Autism Spectrum Disorder Update
Posted on May 28, 2022
Effective July 1, 2022, for our Commercial Members,* Health New England will not cover services related to Autism Spectrum Disorder (ASD) provided under an individualized education program, whether provided by school personnel or by third-party contractor or vendors at the direction of the school personnel. *May be applicable to some Self-Funded plans. Please refer to […]