{"id":8596,"date":"2024-09-09T17:25:51","date_gmt":"2024-09-09T17:25:51","guid":{"rendered":"http:\/\/hnetalk.com\/provider\/?p=8596"},"modified":"2024-09-09T17:25:51","modified_gmt":"2024-09-09T17:25:51","slug":"clinical-review-criteria-9-24","status":"publish","type":"post","link":"http:\/\/hnetalk.com\/provider\/clinical-review-criteria-9-24\/","title":{"rendered":"Clinical Review Criteria (September 2024)"},"content":{"rendered":"<p>Health New England reviews clinical policies and updates accordingly. These policies reside at <a href=\"https:\/\/healthnewengland.org\/Providers\/Resources\"><strong>healthnewengland.org\/Providers\/Resources<\/strong><\/a>. Once on the Resources page, click on <strong><em>Behavioral Health\/Medical Policies <\/em><\/strong>to learn more.<\/p>\n<p>We reviewed the following policies with no substantial changes. We either moved the content into our new template or retired the policy.<\/p>\n<p><strong>Musculoskeletal Surgery: Arthroplasty <em>(Notification of Effective Date Change)\u00a0\u00a0 <\/em><\/strong><\/p>\n<ul>\n<li>Effective 10\/1\/2024<\/li>\n<li>Name changed from Total Ankle Replacement to Musculoskeletal Surgery: Arthroplasty<\/li>\n<li>Added criteria and codes for shoulder, hip and knee joint replacement, and revision: ankle joint replacement.<\/li>\n<li>References updated.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>New Medical &amp; Behavioral Health Policies: <\/strong><\/p>\n<ul>\n<li><em>Home Health Care Services &#8211; Medicaid<\/em>\n<ul>\n<li>New Policy effective 10\/1\/2024 (previously included with Commercial and Medicare Advantage LOB policy).<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Transportation Services<\/strong><\/p>\n<ul>\n<li>Effective 10\/1\/2024<\/li>\n<li>Indications for Coverage Section<\/li>\n<li>Under HNE\u2019s Non-Emergency Transportation Services Benefit:<\/li>\n<\/ul>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>Added language stating a non-emergent transport that will have mileage 150+ miles will require prior authorization<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>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 <a href=\"mailto:providerrelations@hne.com\">providerrelations@hne.com<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>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 [&hellip;]<\/p>\n","protected":false},"author":11,"featured_media":0,"comment_status":"closed","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-8596","post","type-post","status-publish","format-standard","hentry","category-provider-newsletter"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p6ZZHB-2eE","_links":{"self":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8596","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\/11"}],"replies":[{"embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/comments?post=8596"}],"version-history":[{"count":2,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8596\/revisions"}],"predecessor-version":[{"id":8609,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8596\/revisions\/8609"}],"wp:attachment":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/media?parent=8596"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/categories?post=8596"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/tags?post=8596"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}