Posted on February 10, 2020
Health New England’s Clinicial Policies have been updated and can be found at healthnewengland.org/providers/resources. On the Resources page, click on “Behavioral Health/Medical Policies” section to learn of the changes. Effective 4/1/2020 Hyperbaric Oxygen Therapy (Outpatient Services) Added 14 new definitions Made adjustments to the “Criteria for Approval” Removed B: “Requests for HBO Therapy for the […]
Posted on December 16, 2019
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 December 16, 2019
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 December 16, 2019
Beginning January 1, 2020, coding and reporting guidelines on International Normalized Ratio (INR) and Prothrombin Time (PT) for anticoagulation management can be found at healthnewengland.org/provider. Click on Coding Best Practice and read up on “Home & Outpatient International Normalized Ratio Monitoring Services.” INR/PT allows a physician to determine the level of anticoagulation (also called blood […]
Posted on December 16, 2019
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 16, 2019
As a reminder, some of our Medicaid members may be limited in English proficiency and by law have rights mandated by Mass.gov under the Limited English Proficiency laws. If you are caring for one of our Medicaid members members, you are required by MassHealth regulations to provide interpreter services so the member can receive the […]
Posted on December 16, 2019
Health New England’s Clinical Policies have been updated and can be found on the Provider Resources page at healthnewengland.org/providers/resources. On the Resources page, click on “Behavioral Health/Medical Policies” to learn of the changes. Reviewed with Changes effective 1/1/20 Drug Testing (communicated change in November communication) Medical Policies Reviewed with Changes effective 2/1/20 Artificial Intervertebral Cervical […]
Posted on November 18, 2019
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 – click into the Payment Policies section. Most recently, the following policy has been released and/or reviewed: Urine Drug Testing
Posted on November 18, 2019
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 November 18, 2019
Health New England understands urine drug testing is medically necessary and plays an integral role in effective medical management of opioids. It should also be used appropriately to inform clinical decision making. Health New England reimburses for covered, medically necessary drug testing services as defined in our Clinical Review Criteria for Drug Testing guidelines available […]