Posted on June 27, 2019
On Saturday, July 13, 2019, Health New England will be performing some system maintenance which will bring all of our external facing digital solutions down. This includes HNEDirect and healthnewengland.org. The system will be brought down at 4:00 a.m. and will resume connectivity by 5:00 p.m. However, throughout the day, there is a chance you […]
Posted on May 28, 2019
Step Therapy Drug changes effective July 1, 2019: For BeHealthy Partnership to cover the Step Therapy drugs listed here, you first must try the corresponding First Line drugs. If BeHealthy Partnership has paid a claim for the First Line drug within the previous 180 or 360 days (depending on the First Line drug), then you are eligible […]
Posted on May 28, 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 assignment for each […]
Posted on May 28, 2019
As you may or may not know, 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 […]
Posted on May 28, 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 to our […]
Posted on May 28, 2019
In our continued effort to provide more information to you online, we have added a Care Management Solution section to healthnewengland.org/providers/resources. This section provides you easy access to information on eviCore managed services like high cost imaging, sleep study program and genetic testing. We have provided a link to their website, access to obtaining a prior authorization […]
Posted on May 28, 2019
Effective July 1, 2019, the following covered benefits for our Fully Funded Commercial members will be adjusted: Sleep Studies – the limit of two sleep studies per calendar year is removed. Maternity Admissions to Out-of-Plan and PHCS Hospitals for PPO and POS Plans only require prior authorization. Without prior approval, you may have a reduction of benefit. […]
Posted on May 28, 2019
Coming this summer, our members will have access to Rx Savings Solutions, a tool which will help our members find savings on their prescription medications. This tool looks at the medications and prepares a personalized prescription savings plan. When there is an opportunity to save, Rx Savings Solutions notifies our members to review the savings plan. If a […]
Posted on May 28, 2019
Coming this summer, Health New England and Magellan Rx are partnering to offer a more convenient option for our members needing infusion therapy. The Site of Service Program identifies clinically appropriate and convenient options for our members, including receiving infusions in the comfort of their home. When Magellan Rx identifies a member who may benefit from this […]
Posted on May 28, 2019
Health New England’s Clinicial Policies have been updated and can be found on the Provider Resources page at healthnewengland.org/Providers/Resources. Most recently, the following policies have been released and/or reviewed: Medical: Spinal Cord Stimulation (UM300POL) Preimplantation Genetic Testing (PGT) / Preimplantation Genetic Diagnosis (PGD) (UM481POL) Therapeutic Shoe and Orthotic Coverage (UM340POL) Speech Therapy for Autism Disorders […]