{"id":5396,"date":"2020-06-02T17:27:18","date_gmt":"2020-06-02T17:27:18","guid":{"rendered":"http:\/\/hnetalk.com\/provider\/?p=5396"},"modified":"2020-06-02T17:31:59","modified_gmt":"2020-06-02T17:31:59","slug":"clinical-review-criteria-june-2020","status":"publish","type":"post","link":"http:\/\/hnetalk.com\/provider\/clinical-review-criteria-june-2020\/","title":{"rendered":"Clinical Review Criteria &#8211; June 2020"},"content":{"rendered":"<p>Health New England\u2019s Clinical Policies have been updated and can be found at <a href=\"http:\/\/healthnewengland.org\/providers\/resources\" target=\"_blank\" rel=\"noopener\">healthnewengland.org\/providers\/resources<\/a>. Once on the Resources page, click on Behavioral Health\/Medical Policies to learn of the changes.<\/p>\n<p><strong>MEDICAL POLICIES:<br \/>\n<\/strong><br \/>\n<em>Updated Policies Effective 8\/1\/2020:<\/em><\/p>\n<ul>\n<li>Biofeedback for Urinary Diagnoses<\/li>\n<li>Orthognathic Surgery<\/li>\n<li>Rhinoplasty\n<ul>\n<li>Adopted InterQual criteria<\/li>\n<li>InterQual criteria is available upon request<\/li>\n<\/ul>\n<\/li>\n<li>Bone Grafts for Spinal Defects\n<ul>\n<li>Under Definitions: Deleted isthmic spondylolisthesis and isthmus<\/li>\n<li>Updated Criteria for approval<\/li>\n<li>Updated Required Documentation<\/li>\n<li>What is Not Covered:\n<ul>\n<li>A.: Added items 6. through 16.<\/li>\n<li>B.: Deleted entire statement (HNE considers Coflex as Experimental\/Investigational for the following: Commercial and Medicaid lines of business)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>Coflex\n<ul>\n<li>Changed From: Coflex is covered for Medicare line of business **ONLY.**<\/li>\n<li>Changed To: Coflex is NOT covered for any line of business.<\/li>\n<li>Deleted reference to Medicare site<\/li>\n<\/ul>\n<\/li>\n<li>Clinical Trial for Medicare Advantage Members\n<ul>\n<li>Updated Criteria for Approval<\/li>\n<li>Updated What is Not Covered<\/li>\n<\/ul>\n<\/li>\n<li>Clinical Trials\n<ul>\n<li>Added additional disclaimer<\/li>\n<li>Updated phases of clinical trials<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><em>New Policies effective 8\/1\/2020<\/em><\/p>\n<ul>\n<li>Reconstructive Repair of Pectus Excavatum or Pectus Carinatum<\/li>\n<li>Balloon Sinus Dilation of the Eustachian Tubes<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><em>Archived Policies<\/em><\/p>\n<ul>\n<li>Fecal Microbiota Transplant<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><b>BEHAVIORAL\u00a0HEALTH POLICIES:<br \/>\n<\/b><br \/>\n<em>No changes to the following policies:<\/em><\/p>\n<ul>\n<li>Access to Behavioral Health<\/li>\n<li>Day Treatment Services<\/li>\n<li>Concurrent Review for Inpatient Rehab for Substance Use Disorder<\/li>\n<li>Autism Spectrum Disorders<\/li>\n<li>Continuity and Coordination Between Medical Care and Behavioral Healthcare<\/li>\n<\/ul>\n<p><em><br \/>\nThe following change was made:<\/em><\/p>\n<ul>\n<li>Neuropsychological Testing\n<ul>\n<li>Changed the name to identify that this policy is only for Medicare Advantage. Removed any reference to \u201cpsychological testing\u201d as this policy is for NeuroPsych testing.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><em>*Please note new\/revised policies may not appear until closer to the effective date.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Health New England\u2019s Clinical Policies have been updated and can be found at healthnewengland.org\/providers\/resources. Once on the Resources page, click on Behavioral Health\/Medical Policies to learn of the changes. MEDICAL POLICIES: Updated Policies Effective 8\/1\/2020: Biofeedback for Urinary Diagnoses Orthognathic Surgery Rhinoplasty Adopted InterQual criteria InterQual criteria is available upon request Bone Grafts for Spinal [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":4349,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[92],"tags":[],"class_list":["post-5396","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-provider-newsletter"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/hnetalk.com\/provider\/wp-content\/uploads\/2018\/10\/laptop.doc-e1539797356812.png?fit=800%2C547","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p6ZZHB-1p2","_links":{"self":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/5396","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/comments?post=5396"}],"version-history":[{"count":6,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/5396\/revisions"}],"predecessor-version":[{"id":5402,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/5396\/revisions\/5402"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/media\/4349"}],"wp:attachment":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/media?parent=5396"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/categories?post=5396"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/tags?post=5396"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}