Posted on December 5, 2018
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 […]
Posted on December 5, 2018
Reminder for Medicare Providers: As a reminder, Federal law prohibits Medicare providers from collecting Medicare Part A and Medicare Part B deductibles, coinsurance or copayments from those enrolled in the Qualified Medicare Beneficiaries (QMB) program, a dual eligible program that exempts individuals from Medicare cost-share liability. If you are a Medicare provider and have any […]
Posted on December 5, 2018
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 5, 2018
Health New England has joined with other HCAS member health plans to use DirectAssure® to improve the quality and timeliness of health care provider directories. The DirectAssure® solution works within the current workflow of CAQH ProView®, an online database that allows you to input professional and practice information one time and then share it with […]
Posted on December 5, 2018
Health New England is encouraging Medicare Advantage members to schedule their 2019 Annual Wellness Visit or Physical Exam. Both visits are $0 copay visits for Health New England Medicare members. The following is a guideline on the HCPCS codes: *The emphasis of these Preventive Visits will be on prevention and screening, NOT detection and diagnosis. […]
Posted on December 5, 2018
Health New England has partnered with the Alzheimer Association to provide additional resources and services to those taking care of loved ones with Alzheimer’s disease and other related dementias. In 2019, the caregivers of our Medicare members with Alzheimer’s disease or other related dementias can be referred to this organization to participate in a care […]
Posted on December 4, 2018
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 drug and any drug-specific medication management requirements, including quantity limitations, step therapy requirements and prior authorization requirements. Most […]
Posted on December 4, 2018
Effective 1/1/19, Admelog vials and pens are now our preferred insulin. BeHealthy Partnership members currently using Humalog or Novolog products will need to change over to Admelog or obtain a prior authorization. A letter was recently sent to high utilization providers and noted in the November provider communication.
Posted on December 4, 2018
Health New England’s Clinicial Policies on the Provider Resources page at healthnewengland.org/Providers/Resources have been updated. Most recently, the following policies have been released and/or reviewed: Optune Device (Tumor Treatment Fields-TTF) (UM659POL) Home Health Care Services (UM670POL) Bronchial Thermoplasty (UM661POL) Corneal Cross-Linking (UM671POL) Outpatient Physical and Occupational Therapy (UM376POL) Medicaid Utilization Management Decisions (MH-UM038POL) Artificial Intervertebral […]
Posted on November 26, 2018
The following chart defines the changes to the BeHealthy Partnership/Medicaid prescription drug coverage, effective 1/1/2019. These changes are included in members’ coverage notices. Step Therapy Drug changes effective January 1, 2019: For Health New England to cover the Step Therapy drugs listed here, you first must try the corresponding First Line drugs. If Health New […]