{"id":6815,"date":"2021-08-30T17:44:38","date_gmt":"2021-08-30T17:44:38","guid":{"rendered":"http:\/\/hnetalk.com\/provider\/?p=6815"},"modified":"2021-08-30T17:58:29","modified_gmt":"2021-08-30T17:58:29","slug":"provider-update-special-edition-august-2021","status":"publish","type":"post","link":"http:\/\/hnetalk.com\/provider\/provider-update-special-edition-august-2021\/","title":{"rendered":"Provider Update \u2013 Special Edition August 2021"},"content":{"rendered":"

We are happy to share with you this Special Edition August 2021 to update you on the Site of Service Program for our Commercial (Fully Insured) Members.<\/p>\n

If you have any questions about the information in this notice, please contact Health New England Provider Relations 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.<\/p>\n

\u00a0<\/strong>Site of Service Program for Commercial (Fully Insured) Members – Effective October 1, 2021<\/strong><\/p>\n

Effective October 1, 2021, Health New England will require that the administration of the infusion and injectable therapy medications listed below occur in the patient\u2019s home (place of service 12) for Commercial Fully Insured Members. During the pre-certification process with Magellan Rx Management, we will apply this requirement.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Procedure Code<\/strong><\/td>\nBrand Name<\/strong><\/td>\nGeneric Name<\/strong><\/td>\n<\/tr>\n
J3262<\/td>\nACTEMRA<\/td>\ntocilizumab<\/td>\n<\/tr>\n
J1931<\/td>\nALDURAZYME<\/td>\nlaronidase<\/td>\n<\/tr>\n
J0256\/J0257<\/td>\nARALAST NP<\/td>\nAlpha-1-proteinase Inhibitor<\/td>\n<\/tr>\n
J0490<\/td>\nBENLYSTA<\/td>\nbelimumab<\/td>\n<\/tr>\n
J0597<\/td>\nBERINERT<\/td>\nC1 esterase inhibitor<\/td>\n<\/tr>\n
J1556<\/td>\nBIVIGAM<\/td>\nintravenous immune globulin<\/td>\n<\/tr>\n
J1786<\/td>\nCEREZYME<\/td>\nimiglucerase<\/td>\n<\/tr>\n
J0717<\/td>\nCIMZIA<\/td>\ncertolizumab pegol<\/td>\n<\/tr>\n
J0598<\/td>\nCINRYZE<\/td>\nC1 esterase inhibitor<\/td>\n<\/tr>\n
J0584<\/td>\nCRYSVITA<\/td>\nburosumab<\/td>\n<\/tr>\n
J1555<\/td>\nCUVITRU<\/td>\nburosumab-twza<\/td>\n<\/tr>\n
J1743<\/td>\nELAPRASE<\/td>\nidursulfase<\/td>\n<\/tr>\n
J3060<\/td>\nELELYSO<\/td>\ntaliglucerase alfa<\/td>\n<\/tr>\n
J3380<\/td>\nENTYVIO<\/td>\nvedolizumab<\/td>\n<\/tr>\n
J1428<\/td>\nEXONDYS 51<\/td>\neteplirsen<\/td>\n<\/tr>\n
J0180<\/td>\nFABRAZYME<\/td>\nagalsidase beta<\/td>\n<\/tr>\n
J1572<\/td>\nFLEBOGAMMA<\/td>\nintravenous immune globulin<\/td>\n<\/tr>\n
J1566<\/td>\nGAMMAGARD S\/D<\/td>\nintravenous immune globulin<\/td>\n<\/tr>\n
J1561<\/td>\nGAMMAKED<\/td>\nintravenous immune globulin<\/td>\n<\/tr>\n
J1557<\/td>\nGAMMAPLEX<\/td>\nintravenous immune globulin<\/td>\n<\/tr>\n
J1561<\/td>\nGAMUNEX-C<\/td>\nintravenous immune globulin<\/td>\n<\/tr>\n
J1559<\/td>\nHIZENTRA<\/td>\nsubcutaneous immune globulin<\/td>\n<\/tr>\n
J1575<\/td>\nHYQVIA SQ<\/td>\nsubcutaneous immune globulin<\/td>\n<\/tr>\n
Q5103<\/td>\nINFLECTRA<\/td>\ninfliximab-dyyb<\/td>\n<\/tr>\n
J2507<\/td>\nKRYSTEXXA<\/td>\npegloticase<\/td>\n<\/tr>\n
J0221<\/td>\nLUMIZYME<\/td>\nalglucosidase alfa<\/td>\n<\/tr>\n
J1458<\/td>\nNAGLAZYME<\/td>\ngalsulfase<\/td>\n<\/tr>\n
J2182<\/td>\nNUCALA<\/td>\nmepolizumab<\/td>\n<\/tr>\n
J2350<\/td>\nOCREVUS<\/td>\nocrelizumab<\/td>\n<\/tr>\n
J1568<\/td>\nOCTAGAM<\/td>\nintravenous immune globulin<\/td>\n<\/tr>\n
J0129<\/td>\nORENCIA<\/td>\nabatacept<\/td>\n<\/tr>\n
J1459<\/td>\nPRIVIGEN<\/td>\nintravenous immune globulin<\/td>\n<\/tr>\n
J1745<\/td>\nREMICADE<\/td>\ninfliximab<\/td>\n<\/tr>\n
Q5104<\/td>\nRENFLEXIS<\/td>\nInfliximab-abda<\/td>\n<\/tr>\n
J1602<\/td>\nSIMPONI ARIA<\/td>\ngolimumab<\/td>\n<\/tr>\n
J1300<\/td>\nSOLIRIS<\/td>\neculizumab<\/td>\n<\/tr>\n
J3357<\/td>\nSTELARA<\/td>\nustekinumab<\/td>\n<\/tr>\n
J3590<\/td>\nULTOMIRIS<\/td>\nravulizumab<\/td>\n<\/tr>\n
J1322<\/td>\nVIMIZIM<\/td>\nelosulfase alfa<\/td>\n<\/tr>\n
J3385<\/td>\nVPRIV<\/td>\nvelaglucerase alfa<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

If you have any questions or would like to speak to a nurse care manager to discuss alternative sites of administration for your patient(s), please email Magellan Rx Management at MRxMSOS@magellanhealth.com<\/a>, or call (800) 424-1762, Monday through Friday, between 8 a.m. and 5 p.m. Eastern Time.<\/p>\n

Thank you for your cooperation and for the care you provide to our members.<\/p>\n","protected":false},"excerpt":{"rendered":"

We are happy to share with you this Special Edition August 2021 to update you on the Site of Service Program for our Commercial (Fully Insured) Members. If you have any questions about the information in this notice, please contact Health New England Provider Relations at (800) 842-4464, extension 5000. A representative is available Monday […]<\/p>\n","protected":false},"author":1,"featured_media":6816,"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-6815","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\/2021\/08\/MRx_color%402x.png?fit=320%2C78","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p6ZZHB-1LV","_links":{"self":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/6815","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=6815"}],"version-history":[{"count":7,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/6815\/revisions"}],"predecessor-version":[{"id":6823,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/6815\/revisions\/6823"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/media\/6816"}],"wp:attachment":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/media?parent=6815"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/categories?post=6815"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/tags?post=6815"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}