{"id":8678,"date":"2025-05-02T18:54:28","date_gmt":"2025-05-02T18:54:28","guid":{"rendered":"https:\/\/hnetalk.com\/provider\/?p=8678"},"modified":"2025-05-02T18:58:26","modified_gmt":"2025-05-02T18:58:26","slug":"provider-updates-may-2025","status":"publish","type":"post","link":"http:\/\/hnetalk.com\/provider\/provider-updates-may-2025\/","title":{"rendered":"Provider Updates (May 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

 <\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Updates<\/em><\/strong><\/td>\nNotes<\/em><\/strong><\/td>\n<\/tr>\n
Medical Policy<\/strong><\/td>\nRespiratory Pathogen Panel Testing<\/strong><\/p>\n
    \n
  • Effective 07\/01\/2025<\/li>\n
  • CPT codes 87632, 87633, 0223U<\/li>\n
  • Added to the experimental\/investigational list<\/li>\n
  • All lines of business<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Payment Policies<\/strong><\/td>\nAdministrative Necessary Days<\/strong><\/p>\n
    \n
  • Effective 07\/01\/2025<\/li>\n
  • Added new drug codes for denial<\/li>\n
  • G0481-G0483<\/li>\n
  • Medicaid line of business<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Prescription Drugs\u00a0\u00a0<\/strong><\/td>\nHumatin<\/strong><\/p>\n
    \n
  • Effective 07\/01\/2025<\/li>\n
  • Prior Authorization required thru Optum<\/li>\n
  • Commercial line of business<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
 <\/p>\n

 <\/td>\n

Fesoterodine<\/strong><\/p>\n
    \n
  • Effective 07\/01\/2025<\/li>\n
  • No longer requires Step Therapy<\/li>\n
  • Commercial line of business<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Not Covered Drugs with Covered Formulary Alternative<\/strong><\/td>\n\n
    \n
  • The following are for Commercial line of business.<\/li>\n
  • Effective 07\/01\/2025<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
<\/td>\nAmcinonide cream, ointment and lotion<\/strong><\/p>\n
    \n
  • Formulary alternatives:\n
      \n
    • Generic topical steroids such as mometasone, triamcinolone and clobetasol<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
 <\/p>\n

 <\/td>\n

Chlorzoxazone 250 mg tablet<\/strong><\/p>\n
    \n
  • Formulary alternatives:\n
      \n
    • Chlorzoxazone 500 mg tablets<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
<\/td>\nClemastine syrup, suspension and chewable<\/strong><\/p>\n
    \n
  • Formulary alternatives:\n
      \n
    • Clemastine 2.68 mg tablets<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
 <\/p>\n

 <\/td>\n

Clindamycin-tretinoin gel 1.2-0.025%<\/strong><\/p>\n
    \n
  • Formulary alternatives:\n
      \n
    • Topical clindamycin and tretinoin as separate agents<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
<\/td>\nHumira<\/strong><\/p>\n
    \n
  • Formulary alternative:\n
      \n
    • adalimumab biosimilar<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n","protected":false},"excerpt":{"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. 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 […]<\/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-8678","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-2fY","_links":{"self":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8678","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=8678"}],"version-history":[{"count":5,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8678\/revisions"}],"predecessor-version":[{"id":8683,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8678\/revisions\/8683"}],"wp:attachment":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/media?parent=8678"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/categories?post=8678"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/tags?post=8678"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}