{"id":8650,"date":"2025-02-07T13:52:29","date_gmt":"2025-02-07T13:52:29","guid":{"rendered":"https:\/\/hnetalk.com\/provider\/?p=8650"},"modified":"2025-02-07T13:52:29","modified_gmt":"2025-02-07T13:52:29","slug":"medical-policy-update-feb-2025","status":"publish","type":"post","link":"http:\/\/hnetalk.com\/provider\/medical-policy-update-feb-2025\/","title":{"rendered":"Medical Policy Update (Feb. 2025)"},"content":{"rendered":"

Please read the following update related to various Health New England programs and changes that may have an impact on your patients and\/or your practice.<\/p>\n

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.<\/p>\n\n\n\n\n\n\n
\u00a0<\/strong><\/td>\nNotes<\/strong><\/td>\n<\/tr>\n<\/thead>\n
Medicaid<\/strong><\/td>\nAttention:\u00a0Health New England, Inc. Network providers serving Medicaid Members<\/strong><\/p>\n

Each year, MassHealth requires all ACOs to submit paid claims for use in financial settlements and pricing of ACO capitation rates for the ensuing years.\u00a0MassHealth has notified Health New England of the deadline for capture and final submission of paid Rate Year 2024 (RY 2024) service dates (1\/1\/2024 \u2013 12\/31\/2024).\u00a0For RY24, only claims processed and paid on or before 7\/31\/2025 will be considered by MassHealth. <\/strong>In keeping with the deadline, we would like to remind you of the Health New England Timely Filing Policy.\u00a0The Timely Filing Policy requires that all claims must be submitted within ninety (90) days of the latter of the date of service or discharge.\u00a0To comply with the MassHealth deadline and allow Health New England time to process and pay claims, we recommend submitting and resolving all concerns with Health New England claim payments as soon as possible upon your claim submission.\u00a0Claims submitted late and not paid by 7\/31\/25 are subject to denial.<\/td>\n<\/tr>\n

EviCore Radiology Migration<\/strong><\/p>\n

\u00a0<\/strong><\/td>\n

Effective 3\/1\/25: Introducing the CareCore National portal platform.<\/strong><\/p>\n

Effective March 1, 2025, the management of Health New England radiology and cardiology prior authorizations through EviCore will transition from the MedSolutions portal platform to the CareCore National portal platform. While this change will have minimal impact on providers, the steps to submit authorizations through the portal will slightly change. That\u2019s why we\u2019d like to invite you to attend one of our upcoming virtual orientation sessions.<\/p>\n

Join us for a free virtual training session:<\/strong><\/p>\n\n\n\n\n\n\n\n
Date <\/strong><\/td>\nDay<\/strong><\/td>\nTime<\/strong><\/td>\n<\/tr>\n
2\/20\/25<\/td>\nThursday<\/td>\n9:00 a.m.<\/td>\n<\/tr>\n
2\/24\/25<\/td>\nMonday<\/td>\n1:00 p.m.<\/td>\n<\/tr>\n
3\/5\/25<\/td>\nWednesday<\/td>\n11:00 a.m.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

Health New England Migration Provider Orientation<\/strong><\/p>\n

What:<\/strong> A 30-60 minute informational session and demonstration of how to submit prior authorization requests through the new portal platform<\/p>\n

Who:<\/strong> Designed specifically for provider office staff<\/p>\n

When:<\/strong> Various Eastern Time options in December<\/p>\n

Where:<\/strong> Virtual via WebEx<\/p>\n

Register today<\/strong><\/p>\n

    \n
  1. Go to http:\/\/EviCore.webex.com<\/a><\/li>\n
  2. Select \u201cWebEx Training\u201d from the menu bar on the top left<\/li>\n
  3. Click the \u201cUpcoming\u201d tab<\/li>\n
  4. Type \u201cHealth New England Migration Provider Orientation<\/strong>\u201d into the search bar and click \u201cSearch\u201d<\/li>\n
  5. Click \u201cRegister\u201d next to the session you wish to attend and enter your information<\/li>\n<\/ol>\n

     <\/p>\n

    Once you\u2019ve registered, you will receive a confirmation email. Please keep the email so you have the WebEx link, meeting number, password, and call-in number for the session you will be attending. We recommend that you add the session to your calendar so you receive meeting reminders.<\/strong><\/p>\n

    For inquiries regarding the EviCore web portal, email the Web Support team at portal.support@EviCore.com<\/a>, or call (800) 646-0418 (Option 2). For any Client or Provider inquiries not associated with this training, email ClientServices@EviCore.com<\/a> or call (800) 646-0418 (Option 4).<\/td>\n<\/tr>\n

EviCore Radiology<\/strong><\/p>\n

Frequently Asked\u00a0\u00a0\u00a0\u00a0\u00a0 Questions<\/strong><\/td>\n

Who is EviCore healthcare?<\/strong><\/p>\n

EviCore healthcare (EviCore) is an independent specialty medical benefits management company that provides utilization management services for Health New England.<\/p>\n

Which members will EviCore manage for the radiology program?<\/p>\n

EviCore will manage prior authorization for Medicaid, Medicare and Commercial members.<\/p>\n

What is EviCore radiology program? <\/strong><\/p>\n

EviCore\u2019s radiology program consists of Prior Authorization Medical Necessity Determinations for advanced radiological services and Nuclear Cardiac codes.<\/p>\n

Our solution is designed around each client\u2019s individual needs. This is accomplished by utilizing our unique clinical expertise with a staff of 300+ medical directors covering 51 different specialties and 800 licensed nurses with advanced training in various specialties. Additionally, we employ industry-leading clinical guidelines, including pediatric-specific imaging guidelines that incorporate all applicable criteria from medical specialty societies.<\/p>\n

Which radiology\/cardiac services require prior authorization for Health New England Plans?<\/strong><\/p>\n

CPT code list can be found on the resources page:<\/p>\n

Health New England Provider Resources | EviCore by <\/a>Evernorth<\/a><\/p>\n

Radiology<\/strong><\/p>\n