ProviderMatters

Clinical Review Criteria

Posted on April 1, 2024

Health New England reviews clinical policies and updates accordingly. These policies reside at healthnewengland.org/Providers/Resources. Once on the Resources page, click on Behavioral Health/Medical Policies to learn more. The following policies were reviewed: Community-Based Acute Treatment/Youth Clinical Crisis Stabilization (CBAT/YCCS) Program and Intensive Community-Based Acute Treatment (ICBAT) Program (Behavioral Health) Youth Clinical Crisis Stabilization services (YCCS) […]

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Interpreter Services for Medicaid Members (Reminder)

Posted on April 1, 2024

As a reminder, some of our Medicaid/BeHealthy Partnership members may be limited in English proficiency and, by law, have rights mandated by the Commonwealth of Massachusetts under the Limited English Proficiency laws. If you are caring for one of our Medicaid members, MassHealth regulations requires you to provide interpreter services so the member can receive […]

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Product Benefit Updates

Posted on February 26, 2024

Each year, Health New England reviews gaps in care and access to appointments, and works closely with regulatory entities to ensure programs are in place to meet the needs of our members. The following benefits are in place for 2024: Behavioral Health Wellness Effective 4/1/2024, our Fully Funded Commercial* members will have access to one […]

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Signify Health

Posted on February 26, 2024

Beginning March 2024, Signify Health, a current partner for in-home health assessments, will expand to more eligible Medicare and Commercial members throughout our service area. A licensed clinician who reviews medication and medical history does these assessments. They also check vital signs, look for safety risks, and answer health questions. These visits do not replace […]

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Clinical Review Criteria

Posted on February 26, 2024

Health New England reviews clinical policies and updates accordingly. These policies reside at healthnewengland.org/Providers/Resources. Once on the Resources page, click on Behavioral Health/Medical Policies to learn more. The following policies were reviewed: Drug Testing in Substance Use Disorder treatment and Pain Management Name changed from Drug Testing Minor changes to criteria No coding changes   […]

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Provider Directory (Reminder)

Posted on February 26, 2024

Attention Providers and Practice Managers: Accurate provider directories are critical to helping our members make educated decisions about their plan choices. Health New England offers an online directory for all products, and hard copies of each directory are available upon request. In an effort to support the Centers for Medicare & Medicaid Services (CMS), MassHealth, […]

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Payment Policies Update

Posted on February 26, 2024

Health New England is committed to reviewing our internal procedures and define coverage and billing guidelines with applicable laws and industry standards to ensure our policies are appropriate. To access payment policies, please visit healthnewengland.org/Providers/Resources. The following policies were reviewed and updated: If you have any questions about the information in this notice, please contact […]

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Payment Policies Update

Posted on January 30, 2024

Health New England is committed to reviewing our internal procedures and define coverage and billing guidelines with applicable laws and industry standards to ensure our policies are appropriate. To access payment policies, please visit healthnewengland.org/Providers/Resources. The following policies were reviewed and updated: Anesthesia Services Payment Policy – added the QZ modifier

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Formulary Update

Posted on January 30, 2024

Health New England’s formularies are located at healthnewengland.org. At the top of the page, use the “Find A Drug” tool. Changes to policies:   New Policies:   For more information, please do not hesitate to call our Provider Experience Department at (800) 842-4464, extension 5000, or send an email to providerrelations@hne.com.

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