Formulary Update – December 2020
Posted on December 14, 2020
Health New England’s formularies can be accessed on healthnewengland.org using the “Find A Drug” tool at the top of the page.
ProviderMatters
Payment Policy – December 2020
Posted on December 14, 2020
Health New England is committed to review our internal procedures and define coverage and billing guidelines with industry standards to ensure our policies are current. To access payment policies, please visit healthnewengland.org/Providers/Resources. The following will be new effective 1/1/2021 Skilled Nursing Facility (documents current procedures)
MassHealth Updates – December 2020
Posted on December 14, 2020
For our BeHealthy Partnership members and others utilizing MassHealth with their benefits, Health New England follows the guidance provided by the Executive Office of Health and Human Services (EOHHS). Below is a reminder from their recent Bulletin that we are following: Bulleton 301: Impact of COVID-19 on Behavioral Health and the Importance of Perinatal and […]
Clinical Review Criteria – December 2020
Posted on December 14, 2020
Health New England’s Clinical Policies have been updated and can be found at healthnewengland.org/Providers/Resources. Once on the Resources page, click on Behavioral Health/Medical Policies to learn of the changes. Please note, new/revised policies may not appear until closer to the effective date. Reviewed and Updated (Effective date of 2/1/2021 ) Chimeric Antigen Receptor T-Cell Therapy […]
Formulary Update – November 2020
Posted on November 4, 2020
Health New England’s formularies can be accessed on healthnewengland.org using the “Find A Drug” tool at the top of the page.
Clinical Review Criteria – November 2020
Posted on November 4, 2020
Health New England’s Clinical Policies have been updated and can be found at healthnewengland.org/Providers/Resources. Once on the Resources page, click on Behavioral Health/Medical Policies to learn of the changes. New Medical Policies (Effective 12/1/2020) Azedra (iobenguane I 131) Nodify Lung Nodule Risk Assessment BDX-XL2 (Biodesix, Inc.) New Medical Policy (Effective 1/1/2021) Deep Brain Stimulation Treatment […]
Payment Policy – November 2020
Posted on November 4, 2020
Health New England is committed to review our internal procedures and define coverage and billing guidelines with industry standards to ensure our policies are current. To access payment policies, please visit healthnewengland.org/providers/resources. The following policies were reviewed and clarifications were made: • Diabetic Care Payment Policy o Covered Treatment and Services, clarified covered insulin pumps. […]
Code of Conduct, Reporting Issues, Annual Training
Posted on November 4, 2020
It is Health New England’s policy to conduct its business in compliance with all applicable federal and state laws and regulations and to assure that Health New England operates in a manner consistent with the letter and the spirit of the laws. Health New England expects its employees, management, governing body members and first tier, […]
Claims Editing – November 2020
Posted on November 4, 2020
As you know, the Centers for Medicare & Medicaid Services (CMS) has a process for Medicare coverage determination. This includes National Coverage Determinations (NCDs), which are determined through an evidence-based process. In the absence of a national coverage policy, a service may be covered at the discretion of the Medicare contractor using Local Coverage Determinations […]
New Specialty Partnership – (Coming Soon)
Posted on November 4, 2020
Coming soon, Health New England will be working with Healthmap Solutions, Inc. (Healthmap) to provide care coordination services for Medicare Advantage members with chronic kidney disease (CKD) or end-stage renal disease (ESRD). Healthmap is a growing specialty Population Health Management (PHM) company with an industry-leading Kidney Health Management (KHM) program that will greatly benefit our […]