Category Archives: Provider Newsletter

Clinical Review Criteria

Posted on December 28, 2023

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. Endothelial Keratoplasty Retired effective 1/1/2024   Non-Covered, Experimental and Investigational Services Retired effective 1/1/2024 – see Medical Necessity   Lipodystrophy Syndrome – HIV associated Effective 3/1/2024 Name changed […]

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Provider Update – January 2024 Special Edition

Posted on December 28, 2023

Medicare Advantage Open Enrollment Period – January 1 through March 31 Did you know that Medicare offers beneficiaries who are enrolled in a Medicare Advantage plan one last opportunity to switch their plan during the Medicare Advantage Open Enrollment Period (MA OEP)? The Medicare Advantage Open Enrollment period runs from January 1 to March 31 […]

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Provider Manual

Posted on December 28, 2023

Health New England reviews our Provider Manual regularly and notifies you when there are updates. Most recently, we clarified the Post-Service Review definition in our Medical Management section under Utilization Management. We provided more content to this section, which aligns with the policies and procedures we have always followed. Go to https://healthnewengland.org/provider-manual to learn more. […]

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Formulary Update

Posted on December 1, 2023

Health New England’s formularies are located at healthnewengland.org. At the top of the page, use the “Find A Drug” tool. For more information, please do not hesitate to call our Provider Experience Department at (800) 842-4464, extension 5000, or send an email to providerrelations@hne.com.

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Medicare Advantage and Qualified Medicare Beneficiary (QMB) Program

Posted on December 1, 2023

The Qualified Medicare Beneficiary (QMB) Program is one of the four Medicare Savings Programs that allows Enrollees to get help from the state to pay Medicare premiums and cost sharing. Some Health New England Medicare Advantage members have this benefit, and the Federal law prohibits Medicare providers from collecting coinsurance, copayments and deductibles from those […]

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Provider Directory (Reminder)

Posted on December 1, 2023

Attention Providers and Practice Managers: Accurate provider directories are critical to helping our members make educated decisions about their plan choices. Health New England offers an online directory for all products, and hard copies of each directory are available upon request. In an effort to support the Centers for Medicare & Medicaid Services (CMS), MassHealth, […]

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Skilled Nursing Policy

Posted on December 1, 2023

Effective immediately, Health New England (HNE) will begin waiving pre-admission screening of individuals, in all lines of business, seeking admission to skilled nursing facilities (SNF), after normal business hours on Friday through Sunday; Monday, if legal holiday. HNE does require notification of the SNF admission within 48 hours, as well as the anticipated discharge date […]

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Code of Conduct, Reporting Issues and Annual Training

Posted on December 1, 2023

It is Health New England’s (“HNE”) policy to conduct its business in compliance with all applicable federal and state laws and regulations and to assure that HNE operates in a manner consistent with the letter and the spirit of the laws. This Code of Conduct applies to all HNE employees and associates, including members of […]

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Provider Update – Special Edition November 2023

Posted on November 15, 2023

Upgrade to our Core Claims Platform Friday, November 17, through Sunday, November 19, 2023 As part of our continuing commitment to operational improvement, we will be undergoing an upgrade to our Core Claims platform the weekend of Friday, November 17, through Sunday, November 19. As part of this process, all 837 claims files received after […]

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Clinical Review Criteria

Posted on November 1, 2023

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. Cosmetic and Reconstructive Procedures: Coding guidance updated. CPT 15847 not covered for all lines of business.   Knee Braces: Clarification HNE’s policy is retired as of 11/1. Please […]

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