Posted on May 28, 2021
When providing care to our members, whether in person or by way of telehealth, it is important to remember to include the appropriate location of these services in your claim submission. This may result in a separate claim submission for those in-person type services ordered during a telehealth office visit. If the services, which are […]
Posted on May 28, 2021
Effective 8/1/2021, Health New England has decided, for our Commercial members, that HCPCS code L8699, Prosthetic Implants, not otherwise specified,* will no longer be separately reimbursed and the prior authorization requirement removed. If this code is used, you will see a denial stating covered services bundled into payment. For more information, go to healthnewengland.org/Providers/Resources, click […]
Posted on May 28, 2021
Health New England is committed to reviewing our internal procedures and defines 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 policy reviewed and updated: Unlisted Procedures & Services
Posted on May 28, 2021
Health New England continues to allow clinically appropriate and medically necessary telehealth services with our in-network providers through the state of emergency. However, effective 7/1/2021, we will resume applying member cost sharing for non-COVID-19 related medically necessary telehealth services.* *Some self-funded employer groups do not participate in Health New England’s Teladoc benefit and decided not […]
Posted on May 28, 2021
Health New England’s formularies are located at healthnewengland.org. At the top of the page, use the “Find A Drug” tool.
Posted on May 28, 2021
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. To view all of June 2021 clinical policies updates, click here.
Posted on March 31, 2021
In addition, the following coverage determinations apply to these HCPC codes:
Posted on March 30, 2021
Policy Number: UM727POL Effective Date: 6/1/2021 LOB Affected: Commercial, Medicare, Medicaid Policy Type: Medical Definitions: Added 2 definitions: Ablation and Radiofrequency Energy Source/Citation Section: Checked links and added 4 references
Posted on March 30, 2021
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 March 30, 2021
At Health New England, providers have the right to file an appeal if they disagree with how we processed a claim. If you choose to have a claim payment reviewed, you must do so within 12 months from the date of services or date of discharge for inpatient services. We also ask that you reference […]