Posted on April 26, 2022
Below is some important information regarding Spinraza and Zolgensma and our Commercial Members. Beginning May 27, 2022, Providers will continue to follow Health New England’s process through Magellan, but Accredo Health Services will exclusively distribute Spinraza and Zolgensma. Once the approval has been obtained from Magellan, you may order the medication directly from Accredo at […]
Posted on March 21, 2022
As you may know, two different patient satisfaction surveys impact a health plan’s CMS Star ratings: The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey is typically mailed to Plan members from March to June. The Health Outcomes Survey (HOS) is typically mailed to members July through November 2022. EOHHS and CMS have […]
Posted on March 18, 2022
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. Please note, new/revised policies may not appear until closer to the effective date.
Posted on March 18, 2022
Health New England’s formularies are located at healthnewengland.org. At the top of the page, use the “Find A Drug” tool.
Posted on March 17, 2022
The National Committee for Quality Assurance standardized measurement criteria, known as the Healthcare Effectiveness Data and Information Set (HEDIS) is underway. During the month of March, you may have received a letter from Health New England’s Quality Management team requesting copies of medical information. As a reminder, all of the medical information requested is due […]
Posted on March 17, 2022
Health New England has added a birthing center to our network. With this addition, we have informed our members that effective July 1, 2022, Member Cost Share for inpatient maternity care will apply to care at an in-plan birthing center. For any questions you may have, please call your Provider Relations Representative at (800) 842-4463, […]
Posted on March 17, 2022
Health New England is committed to reviewing our internal procedures and define coverage and billing guidelines with applicable laws and industry standards to ensure our policies are appropriate. To access payment policies, please visit healthnewengland.org/Providers/Resources. The following policies were reviewed and updated: Evaluation and Management – clarification – corrected prolonged services codes (page 4) Non-Reimbursable […]
Posted on March 17, 2022
Effective July 1, 2022, Health New England’s Lab Management Guidelines will update. To review the new version (V2.0.2022), visit this page. The guidelines are located under the “future” tab. You may also go to the Clinical Guidelines page, click Laboratory Management. In the center of the page, enter “Health New England” in the search. You […]
Posted on March 17, 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 Centers for Medicare & Medicaid Services (CMS), MassHealth, The […]
Posted on February 2, 2022
Medicare 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 Open Enrollment Period (OEP)? The Medicare Open Enrollment period runs from January 1 to March 31 each year. During this […]