ProviderMatters

Medical Policy Updates (March 2026)

Posted on February 27, 2026

Please read the following update related to various Health New England programs and changes that may have an impact on your patients and/or your practice. To find policies noted below, please visit healthnewengland.org/Providers/Resources.

If you have any questions about the information in this notice, please contact Health New England Provider Experience at (800) 842-4464, extension 5000. A representative is available Monday through Friday between the hours of 8:00 a.m. and 5:00 p.m.

Updates  Effective Date Notes
Medical Policy
Prior Authorization:
Concurrent Review Process Update		 05/04/2026 Beginning 5/4/2026, Health New England will process the following types of requests as concurrent reviews.

  • All lines of business
  • Revised Concurrent Review for prior authorization requests
    • Treatments requiring Initial and Subsequent
      • Outpatient Physical and Occupational Therapy
      • Speech Language Pathology Services
      • Speech Therapy for Autism Disorders
      • Community Crisis Stabilization (CSU/CCS)
      • Implantable peripheral nerve stimulation (PNS)
      • Peripheral nerve stimulation (PNS)
      • GIC Fertility
      • CardioMEMS
    • Treatments requiring Subsequent ONLY
      • Ambulatory Cardiac Monitoring
      • Implantable Neurostimulators
      • Neurostimulators
      • Clinical Trials
      • Contact Lenses
      • Hyperbaric Oxygen Therapy
      • Infertility treatment
      • Lutetium Therapeutic Radiopharmaceuticals
      • Percutaneous Neuroablation
      • Proton Beam Therapy
      • Sleep Studies
      • Therapeutic Shoe and Orthotic Coverage
      • Tumor Treatment Fields
      • Intradialytic Parenteral Nutrition
      • Organ Transplants

What does this mean for you? Quicker turnaround times for decisions on prior authorization requests.

What is needed from you? Please be sure to submit clinical documentation supporting medical necessity with your request for prior authorization. If unsure what to submit with your request, please refer to our medical policies on our website at https://healthnewengland.org/Providers/Resources. They indicate the medical necessity criteria for services.

Please note: Failure to submit the information in a timely manner may result in a denial.

 

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