Posted on May 4, 2020
At Health New England, we try our best to provide guidance on coding best practices. Due to COVID-19, we recently added the following “State of Emergency” tip sheets to communicate how we are following guidance from the Centers for Disease Control and Prevention (CDC), Centers for Medicare & Medicaid Services (CMS), the Division of Insurance, […]
Posted on May 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. Effective 6/1/2020 Chondrocyte Transplant to the Knee • Added 4 definitions • Updated criteria “For Approval” with adds, deletes and clarifications • Updated “What is Not […]
Posted on March 12, 2020
Effective May 12, 2023 – Changes to Over-the-Counter COVID-19 Test Kit Coverage Health New England covered the costs of FDA-authorized, rapid, at-home COVID-19 tests and will continue to cover until the end of the public health emergency (PHE), which will end on May 11, 2023. Any reimbursement requests for test kits purchased before May 12, […]
Posted on February 10, 2020
Attention Practice Managers: Accurate provider/pharmacy directories are critical to helping our members make educated decisions about their plan choices. Health New England offers an online directory for all of our products. In addition, hard copies of each directory are available upon request. In an effort to support both CMS and NCQA requirements, we reach out […]
Posted on February 10, 2020
Health New England has an automated review of claims against accepted industry rules and coding guidelines. The sources for coding rules and edits may include, but are not limited to, the following: CPT, ICD, CMS and Health New England Payment Policies. This automated update and review takes place quarterly. For more information on the guidelines […]
Posted on February 10, 2020
Health New England’s formularies can be accessed on healthnewengland.org using the “Find A Drug” tool at the top of the page. The online formularies are updated throughout the year as changes are made. We have three formularies, one for each line of business – Commercial, Medicare Advantage and BeHealthy Partnership/Medicaid. Each formulary includes the tier […]
Posted on February 10, 2020
In October, we shared a new benefit for 2020. Our Medicare Advantage members have the opportunity to be referred to Mom’s Meals to receive 28 fully-prepared, nutritional meals after discharge from an inpatient hospital stay. Within 30 days after discharge, our Care Management team will reach out to the member to select meals from available […]
Posted on February 10, 2020
With the new year upon us, this is when most updates take place. Please remember to go to the portal at eviCore.com to review prior authorization and codes. If you need additional information, please call your Provider Relations Representative at (800) 842-4464, ext. 5000, or send an email to ProviderRelations@hne.com.
Posted on February 10, 2020
Northwood, our durable medical equipment benefit manager has updated their managed code listing as of January 1, 2020. This new listing can be found at healthnewengland.org/providers/resources. Under Durable Medical Equipment (DME), you will find information on managed codes, FAQs and a link to Northwood’s website. For more information, please call your Provider Relations Representative at […]
Posted on February 10, 2020
As part of our effort to improve the experience you have with Health New England, we worked diligently over the last year with our claims payment system to accept the automatic transfer of Medicare processed claim data for our Medicare Beneficiaries. We are happy to share that there is no longer a need to send […]