ProviderMatters

Payment Policies Update (October 2024)

Posted on October 8, 2024

Health New England is committed to reviewing our internal procedures and defining 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:   Policy  Effective Date  Summary of Changes  Individual Consideration Services   10/1/2024  Removed bullet on additional […]

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Clinical Review Criteria (September 2024)

Posted on September 9, 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. We reviewed the following policies with no substantial changes. We either moved the content into our new template or retired the policy. Musculoskeletal Surgery: Arthroplasty (Notification of Effective […]

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New Payment Policies (September 2024)

Posted on September 9, 2024

Unlisted Procedures & Services: Billing & Documentation Requirements Section Added block for Anesthesia Services Unlisted coded within the range of 00100 – 01999 along with documentation requirements.   Medical Health Policies: Non-Emergent Transportation Effective 11/2/2024 Medicaid/BeHealthy transportation is directly covered by MassHealth – policy does not apply. For Medicare Advantage, will continue to follow guidance […]

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Payment Policy Updates (September 2024)

Posted on September 9, 2024

Health New England is committed to reviewing our internal procedures and defining 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: Balloon Dilation of the Eustachian Tube Effective 9/1/2024 Updated policy- procedures described by […]

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Update from Medical Technical Advisory Committee (MTAC)

Posted on September 9, 2024

Percutaneous hemodialysis arteriovenous (AV) fistulas are created using endovascular techniques without the need for a surgical incision and are also termed endo-AV fistulas or endoAVFs. 36836 describes the Ellipsys Vascular Access System. Under high frequency ultrasound guidance, an outer access cannula, guidewire, and vessel capture construct creates a connection of the vein to the artery […]

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Clinical Review Criteria (August 2024)

Posted on August 5, 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. Percutaneous Neuroablation Effective 8/1/2024 Updated with non-coverage of Intraosseous Basivertebral Nerve Ablation (CPT codes 64628 and 64629) as it is not covered by MassHealth. Cosmetic and Reconstructive Procedures […]

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Formulary Update (July 2024)

Posted on July 2, 2024

Health New England’s formularies are located at healthnewengland.org. At the top of the page, use the “Find A Drug” tool. Prescription Drug Coverage- Commercial Note: Tier 1 – lowest copay level; Tier 2 – mid copay level; Tier 3 – highest copay level For 5-tier formulary- Tier 4-lowest specialty tier; Tier 5-highest specialty tier Step […]

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Payment Policy (July 2024)

Posted on July 2, 2024

Health New England is committed to reviewing our internal procedures, and defining 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. Discarded Drugs & Biologicals Effective 6/1/2024 Reviewed with no changes Evaluation & Management Professional Services Effective 6/1/2024 Removal of expired codes […]

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Clinical Review Criteria (July 2024)

Posted on July 2, 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. Breast Surgery Updated to remove reference to Schnur Sliding Scale as this scale is no longer used No change to effective date of 8/1/2024   Prostate Procedures (BPH […]

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Payment Policy (June 2024)

Posted on June 4, 2024

Health New England is committed to reviewing our internal procedures, and defining 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. Vaccines & Immunizations Effective 5/1/2024 Added Industry Standard Language Added additional language to Non-State Supplied Vaccines under Commercial Conditional Formatting Inpatient […]

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