Commercial Fully Funded Amendment: Effective 1/1/2022
Posted on October 29, 2021
View changes to prescription drug coverage effective 1/1/2022.
ProviderMatters
Commercial Fully Funded Pharmacy Updates: Effective 1/1/2022
Posted on October 29, 2021
Effective 1/1/2022, Health New England is adding a 5-Tier Pharmacy options for certain Commercial plans. When caring for our members, please reference our Formulary Lookup to understand their benefit coverage and impacts to copayments.
Medicare Product Updates: Effective 1/1/2022
Posted on October 29, 2021
Effective 1/1/2022, our Medicare Advantage product has added two PPO plans, one called Compass and the other Compass Premier, and a new travel benefit under these plans. We will also be closing the Select (HMO-POS) plan effective 12/31/2021. It is important when making appointments with our Medicare members that you reference their ID Card to […]
November 2021 Clinical Review Criteria
Posted on October 29, 2021
Each month, Health New England reviews clinical criteria and policies with our Clinical Care Advisory Committee and Medical Technology Assessment Committee. When changes occur, we update policies, if applicable, and inform our network accordingly. Below are recent updates you need to know when caring for our members: For Fully Funded Commercial and Medicaid, the following […]
October 2021 – Formulary Update
Posted on September 30, 2021
Health New England’s formularies are located at healthnewengland.org. At the top of the page, use the “Find A Drug” tool.
Provider Directory Validation and CAQH Initiative
Posted on September 30, 2021
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 Centers for Medicare & Medicaid Services (CMS), MassHealth, The […]
EOHHS Updates
Posted on September 30, 2021
In partnership with the Executive Office of Health and Human Services (EOHHS), we have been asked to share the following: • The My Account Page in the Virtual Gateway is now read-only. You are no longer able to update information on the page. • Recent announcement regarding the mandates of the COVID-19 vaccine for Long […]
Early Intensive Behavioral Intervention Services
Posted on September 30, 2021
Early Intensive Behavioral Intervention Services (EIBI) is a treatment based on the principles of applied behavior analysis (ABA). The treatment offers someone who is diagnosed with autism the opportunity for improved learning, skill development and behavior changes. When a Health New England member requires this type of treatment, a prior authorization is required. However, the […]
Colorectal Cancer Screening
Posted on September 30, 2021
Age limit lowered to 45 (Commercial Members) Recently, the U.S. Preventive Services Task Force (USPSTF) lowered the recommended age for colorectal cancer screening from 50 to 45, expanding the range to 45 – 75 years. With that said, effective January 1, 2022, Health New England recommends and will cover the screening of all Fully Insured […]
October 2021 Payment Policies
Posted on September 30, 2021
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 policy was created: COVID-19 Vaccination – documented current procedures The following policies were reviewed and updated: Claims Editing […]