Northwood (Reminder)
Posted on August 1, 2023
Health New England partners with Northwood, Inc., our durable equipment benefit manager, for authorizations. This includes the management of durable medical equipment (DME), medical supplies, prosthetic and orthotic for all our members.
It is important to know that timely and complete submission of clinical documentation to support medical necessity is key to receiving faster responses on authorization for DME requests. Furthermore, the National Committee for Quality Assurance (NCQA) and the Centers for Medicare & Medicaid Services (CMS) requires Health New England respond to authorization requests within certain timeframes. Therefore, it is key that Northwood receives clinical information that supports the medical necessity and appropriateness for treatment and diagnosis of the member at the time the request is received. Otherwise, requests for DME may deny if information needed to issue a decision is missing or not received timely.
Additionally, when ordering the DME or Prosthetic/Orthotics through one of Northwood’s contracted DME/PO suppliers, if all clinical and prescription information for that member is not included for authorization determination, a request for information letter to obtain the missing information will be sent to you and needs to be responded to immediately, otherwise the request will be denied.
For more Information regarding Northwood and policies for each line of business, please go to healthnewengland.org/providers/resources. Under Durable Medical Equipment (DME), you will find information on managed codes, FAQs and a link to Northwood’s website.
You may also call your Provider Relations Representative at (800) 842-4464, ext. 5000, or send an email to ProviderRelations@hne.com.
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