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. […]
Posted on November 30, 2021
Please note, new/revised policies may not appear until closer to the effective date. 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. Medical Updates: Behavioral Health Updates:
Posted on November 30, 2021
Health New England’s formularies are located at healthnewengland.org. At the top of the page, use the “Find A Drug” tool. Brand Name Bafiertam Generic Name Bafiertam Brand Name Fotivda capsules Generic Name Tivozanib Brand Name Kerendia tablets Generic Name Finerenone Brand Name Kesimpta Generic Name Ofatumumab Brand Name Lumakras tablets Generic Name Sotorasib Brand Name […]
Posted on November 30, 2021
Back in October, we reached out asking for those in our network to let us know who treats PANDAS/PANS and to fill out an availability assessment. We are looking for this information to better serve our members. Per state mandate (Chapter 260, Acts of 2020), and effective for Commercial Fully Funded plans that are issued […]
Posted on October 29, 2021
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 […]
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 […]