Formulary: February 2022 Update
Posted on January 25, 2022
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
Payment Policy: February 2022 Update
Posted on January 25, 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: Telehealth Services Payment Policy Evaluation and Management Payment Policy For additional questions, […]
Provider Manual Updates: February 2022
Posted on January 25, 2022
Health New England reviews our provider manual regularly and notifies you when there are updates. Most recently, we updated the following sections: Member Information (https://healthnewengland.org/providers/provider-manual/member-information) With the recent No Surprise mandate, our Member ID Cards were updated. We have displayed an accurate representation of our cards. Under the Member’s Right to Appeal, we include information […]
Interactive Voice Response (IVR)
Posted on January 25, 2022
We communicated back in July 2021 about our new interactive voice response (IVR) system, which is a quick and efficient self-service tool offering direct access to claims and eligibility status 24 hours a day, 7 days a week. We are now live with this tool, and have taken the feedback we heard from our provider […]
Companion Guide: February 2022
Posted on January 25, 2022
With the recent introduction of taxonomy numbers for certain claims payment, we updated our 837 5010 Claims Companion Guide to clarify when to use this number. In addition, we corrected our documentation regarding Coordination of Benefit (COB) claims for other payers. Go to https://healthnewengland.org/Providers/Resources, click HIPAA Transactions, click 837 5010 Claims Companion Guide. Please see […]
Drug Look Up Tool 2022 Update
Posted on December 23, 2021
Effective 1/1/2022, for our Commercial and Medicaid members, Health New England is following others in the industry and moving our formulary look up tool to OptumRx. You should be familiar with the tool if you provide service to our Medicare Advantage members. If you do not, this will still be an easy transition. In addition, […]
Services Requiring Authorization
Posted on December 23, 2021
Services requiring authorization, including same-day services: As a reminder, when caring for our members and during a course of treatments, it is important to know what services are covered under the member’s benefit plan, as well as what services require authorization. When services are performed that are not covered nor approved, including those provided on the […]
Northwood 2022 Update
Posted on December 23, 2021
Northwood: Durable Medical Equipment Benefit Manager Northwood, our durable medical equipment benefit manager, has updated their managed code listing as of January 1, 2022. This new listing can be found at healthnewengland.org/providers/resources. Under Durable Medical Equipment (DME), you will find information on managed codes, FAQs and a link to Northwood’s website. For more information, please call […]
Evicore 2022 Updates
Posted on December 23, 2021
EVICORE: Care Management Solutions for High Cost Imaging, Sleep Study Program and Genetic Testing With the new year upon us, this is when most updates take place. Please remember to go to the portal at eviCore.com to review prior authorization and codes. If you need additional information, please call your Provider Relations Representative at (800) 842-4464, […]
January 2022 Clinical Review Criteria
Posted on December 23, 2021
Each year, new procedure codes (CPT) and Healthcare Common Procedure codes (HCPC) as well as changes to current codes are released to every health plan by the American Medical Association (AMA) and Centers for Medicare & Medicaid Services (CMS). In addition, Health New England reviews clinical policies and updates accordingly. These policies reside at healthnewengland.org/Providers/Resources. […]