Formulary Update
Posted on March 29, 2023
Health New England’s formularies are located at healthnewengland.org. At the top of the page, use the “Find A Drug” tool.
Category Archives: Provider Newsletter
Clinical Review Criteria
Posted on March 29, 2023
On a regular basis, Health New England reviews our clinical criteria for our Behavioral Health and Medical policies, as well as the criteria for the drugs included in our formulary. This notification outlines changes to those policies recently reviewed. Health New England reviews clinical policies and updates accordingly. These policies reside at healthnewengland.org/Providers/Resources. Once on […]
Provider Update – Special Edition December 2022 (Revised 3/9/23)
Posted on March 9, 2023
We are happy to share with you this Special Edition December 2022 to update you on good faith admissions to skilled nursing and acute rehabilitation facilities from the acute care setting. Acute Care Setting to Skilled Nursing and Acute Rehab Facilitates Effective December 6, 2022 – April 20, 2023 for our Commercial (fully funded)*, BeHealthy […]
BeHealthy Partnership and Pharmacy Drug Authorizations
Posted on March 8, 2023
With Health New England’s continued participation in the Accountable Care Partnership Plan, otherwise known as the BeHealthy Partnership, there are some important reminders beginning April 1, 2023, due to changes with medication management with our pharmacy benefit managers. When researching coverage details of a pharmacy drug, please remember to go https://healthnewengland.org/pharmacy/find-drug and click on MassHealth/BeHealthy […]
eviCore Authorization
Posted on March 8, 2023
Health New England, in partnership with eviCore Healthcare, our authorization manager for high-cost imaging, sleep study and genetic testing, has made a decision to change the allowed time between approval and rendering of the services with high-cost imaging for all of our lines of business. Effective April 1, 2023, our Commercial, Medicare and Medicaid members […]
Provider Update – Special Edition January 2023
Posted on January 30, 2023
We are happy to share with you this Special Edition January 2023 to update you on the BeHealthy Partnership program. BeHealthy Partnership Update Health New England is committed to keeping all of our providers informed of plan changes and other updates related to our lines of business. We are happy to share that effective April […]
Medical Record Retrieval Program
Posted on January 12, 2023
Health New England has initiated a program to better serve our members — your patients — with a process that more accurately reports their health status and clinical risk profile. As part of our annual risk adjustment process, we will be conducting reviews of our members’ medical records. This review ensures that all ICD-10 codes […]
Division of Insurance Notifications
Posted on December 28, 2022
Effective 1/1/2023 or in accordance with the Division of Insurance final notifications, Health New England will be updating how we cover abortions and abortion-related services to meet the requirements. In addition, we will follow the final guidance regarding medical malpractice coverage for providers of reproductive or gender-affirming health care services, as it is applicable to […]
Provider Manual
Posted on December 28, 2022
Health New England reviews our provider manual regularly and notifies you when there are updates. Most recently, we updated the Billing and Reimbursement section. Go to healthnewengland.org/providers/provider-manual/billing-reimbursement, click Claims Submission and Reimbursement. In the Claims Submission and Reimbursement section: We removed references to global, consult codes, and modifiers where Health New England now has payment policies. […]
Provider Directory: Reminder
Posted on December 28, 2022
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, […]