Posted on October 29, 2021
Back in February 2019, Health New England announced our partnership with Zelis to review claim submission against industry-recognized guidelines and to ensure compliance with proper coding principles. As part of the review and on behalf of Health New England, Zelis sends appropriate letters when they need further review of the claim information. In some cases, […]
Posted on October 29, 2021
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 […]
Posted on October 29, 2021
Health New England reviews our provider manual on an annual basis, but when changes occur during the year, we try our best to update immediate and notify. Most recently, we updated our Care Management and Utilization Management sections under Medical Management. The updates reflect the onboarding of our specialty partners, ProgenyHealth and Healthmap Solutions. This […]
Posted on October 29, 2021
Effective 1/1/2022, and in accordance with the Consolidated Appropriations Act: No Surprise Act and the Massachusetts Chapter 260 of the Acts of 2020, Health New England will apply the following regulatory requirements. Balance Billing Protection from Out-of-Network Providers: The federal “No Surprises Act” creates a process which providers must follow in order to balance bill. […]
Posted on October 29, 2021
Effective 1/1/2022, we will be re-introducing certain requirements with injectable and infusion drugs with our Site of Service program through Magellan. As you remember, back in August, we introduced new requirement changes but placed the launch on hold due to numerous questions from our network of providers. With that said, we took the opportunity to […]
Posted on October 29, 2021
Health New England supports providers and members in taking an active role to prevent disease. With the ongoing COVID-19 pandemic, vaccination for COVID-19 and influenza are especially important. As highlighted by the Centers for Disease Control and Prevention (CDC), influenza vaccine may be administered at the same time as COVID-19 vaccine. Some key changes for […]
Posted on October 29, 2021
View changes to Medicaid prescription drug coverage effective 1/1/2022.
Posted on October 29, 2021
View changes to prescription drug coverage effective 1/1/2022.
Posted on October 29, 2021
Effective 1/1/2022, Health New England is adding a 5-Tier Pharmacy options for certain Commercial plans. When caring for our members, please reference our Formulary Lookup to understand their benefit coverage and impacts to copayments.
Posted on October 29, 2021
Effective 1/1/2022, our Medicare Advantage product has added two PPO plans, one called Compass and the other Compass Premier, and a new travel benefit under these plans. We will also be closing the Select (HMO-POS) plan effective 12/31/2021. It is important when making appointments with our Medicare members that you reference their ID Card to […]