ProviderMatters

Payment Policy Updates/New Policy (July 2025)

Posted on July 2, 2025

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 
Facility Routine Services, Supplies and Equipment  9/1/2025 
  • All LOBs
  • Updated with current codes
Re-admission to Inpatient Level Care (60 Day Notification) 9/1/2025 
  • All LOBs
  • Changed the Purpose
  • Changed the Readmission Review Definition
  • Adjusted Indications to Pre & Post Payment review and added Planned Readmission (Leave of Absence)
  • Adjusted the Claims Processing section to reflect Pre & Post Payment review
Audit Program (60 Day Notification)   9/1/2025 
  • All LOBs
  • Changed the Purpose to accurately reflect the policy, including shortening company to read “HNE.”
  • Changed the Objective to accurately reflect the policy.
  • Changed the Overview to add HNE specifics regarding designees, shortened the lengthy list of audit review areas, and adjusted the guidelines to accurately reflect our current process.
  • Deleted duplicative language throughout the policy.
  • Added FWA policy link to Resources.   

 

The following policy has been added:  

Policy  Effective Date  Summary
Pre/Post Claims Payment Reviews  9/1/2025 
  • All LOBs
  • New Policy outlining how Health New England (HNE) analyzes claims data

 

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. You may also send an email to providerrelations@hne.com. 

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Categories: Provider Newsletter

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