Posted on September 27, 2019
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 September 27, 2019
Reporting Concerns: All Covered Individuals are required to promptly report potential compliance, or fraud, waste and abuse (FWA) issues of which they have knowledge or a good faith belief. Report in one of the following ways: a) Report to Health New England Compliance: compliancedepartment@hne.com. b) Call the Health New England Compliance hotline toll-free at (800) […]
Posted on September 27, 2019
A recent assessment of our system identified some sleep DME, genetic testing and high cost imaging codes paying without a prior authorization. Our system has since been corrected. To ensure your claims pay accordingly, you should always reference eviCore’s managed code list. You can do this by going to www.eviCore.com or www.healthnewengland.org/providers, click Learn More […]
Posted on September 27, 2019
Quality of care for our members is a priority. This is why we require ACR accreditation when performing high cost imaging services. When the accreditation evaluation is complete or when you renew, a certificate is awarded to you. As a reminder, this certificate is as important to Health New England and our Care Management Solutions vendor, […]
Posted on September 27, 2019
Effective 1/1/2020, the calendar year limit for physical and occupational therapy is changing to a combined 60 visits per calendar year. This calendar year limit change does not apply to services that are part of the home health plan or services provided to treat autism spectrum disorder. Those services require a prior approval. A communication […]
Posted on September 27, 2019
Effective 1/1/20, one of our self-funded employer groups, Baystate Health, will be covering 100% of the cost of the Cologuard test for their employees and NO prior authorization is needed. As a provider, you will need to see your patient’s member ID card to know if a prior authorization is needed prior to ordering the […]
Posted on September 27, 2019
Effective 1/1/20, our Medicare Advantage members will have the opportunity to be referred to Mom’s Meals NourishCare® for complete nutritional meals after discharge from an inpatient hospital stay. Here is how it works: Following a hospital stay, our Care Management team will work with the member to select a meal from available categories such as […]
Posted on September 27, 2019
Health New England’s Clinicial 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 12/1/2019 Surgical Management of Morbid Obesity Abdominal Panniculectomy Contact Lenses Cochlear Implants and BAHA (Bone Anchored Hearing Aid) […]
Posted on September 27, 2019
Back in May of 2019, we announced Health New England was providing our Fully Funded Commercial members with a new pharmacy savings tool called Rx Savings Solutions. This tool will help these members save money and better manage their prescription costs. If one of our members decides to take the opportunity to save, Rx Savings […]
Posted on September 27, 2019
As part of Health New England’s commitment to provide ways on keeping health care costs down for our members, our Medicare Advantage product line is changing our pharmacy benefits manager from Castia Rx to OptumRx®. Beginning January 1, 2020, OptumRx will administer prescription drug benefits for our Medicare Advantage members. New ID Card Issued to […]