April 2021 – Formulary Update
Posted on March 30, 2021
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
MassHealth Dental Program
Posted on March 30, 2021
Health New England is helping to spread the word for Massachusetts Executive Office of Health and Human Services (EOHHS) on the MassHealth Dental Program. Effective January 1, 2021, patients over the age of 21, who have MassHealth coverage, are now able to access a greater number of dental services. EOHHS recommends when visiting with your […]
Clinical Review Criteria Update – Radiofrequency Ablation
Posted on March 30, 2021
Policy Number: UM433POL Effective Date: 6/1/2021 LOB Affected: Commercial, Medicare, Medicaid Policy Type: Medical Added 11 definitions I., Criteria for Approval Added LCD link to use for all lines of business to determine if member meets criteria Original Sections I. and II. The information originally included in Sections I. and II. was deleted. II., What […]
Clinical Review Criteria Update – Photochemotherapy (PUVA), Phototherapy, Laser Treatments
Posted on March 30, 2021
Policy Number: UM460POL Effective Date: 6/1/2021 LOB Affected: Commercial, Medicare, Medicaid Policy Type: Medical I., Criteria for Approval of Photochemotherapy (PUVA) with Psoralens (96912, 96913) C.: Added 7. (Nursing mothers) and 8. (History of lupus erythematosus) III., A.: 4., b.: From: b., Vitiligo when both criteria below are met: i., Involves <5 % of BSA; AND […]
Clinical Review Criteria Update – Blepharoplasty and Browplasty
Posted on March 30, 2021
Policy Number: UM247POL Effective Date: 6/1/2021 LOB Affected: Commercial, Medicare, Medicaid Policy Type: Medical I., Criteria for Approval: Added “for Commercial and MassHealth” Added InterQual language for Commercial and Medicaid : Deleted statements 1-4 previously listed under section A. : Updated/corrected the link for Medicare for Blepharoplasty and Browplasty for Medicare Advantage (deleted Medicare LCD […]
Clinical Review Criteria Update – Spinal Cord Stimulation
Posted on March 30, 2021
Policy Number: UM300POL Effective Date: 6/1/2021 LOB Affected: Commercial, Medicare, Medicaid Policy Type: Medical Definitions Added Nociceptive Pain and Spinal Cord Stimulator • I., Criteria for Approval B. o Added #2. o Changed 4: From: The treatment is a last resort, for chronic conditions with documentation of > 12 months of ineffective treatment and when […]
Clinical Review Criteria Update – Preimplantation Genetic Testing for Monogenic/Single Gene Defects (PGT-M)
Posted on March 30, 2021
Policy Number: UM481POL Effective Date: 6/1/2021 LOB Affected: Commercial Policy Type: Medical Title of Policy changed: From: Preimplantation Genetic Testing (PGT) / Preimplantation Genetic Diagnosis (PGD) To: Preimplantation Genetic Testing for Monogenic/Single Gene Defects (PGT-M) Definitions: Eliminated Preimplantation Genetic Diagnosis (PGD) Added under Preimplantation Genetic Testing for Aneuploidy (PGTA): Not covered by HNE Removed definition of PGT-A […]
New Billing Tip Sheet Now Available: Multiple Diagnosis Capture
Posted on February 10, 2021
At Health New England, our job is to keep health care simple. In doing so, we want to offer some helpful tips and best practices when working with us. From guidance associated with codes, documentation, prior approvals and awareness around compliance, you will find it here. Access our newest billing tip sheet for Multiple Diagnosis Capture […]
Formulary Update – February 2021
Posted on February 10, 2021
Health New England’s formularies can be accessed on healthnewengland.org using the “Find A Drug” tool at the top of the page. Brand Name: Asceniv Generic Name: immune globulin Brand Name: Darzalex Faspro Generic Name: daratumumab-hyaluronidase FIHJ Brand Name: Evomela Generic Name: melphan Brand Name: Hemady Generic Name: dexamethasone Brand Name: Jelmyto Generic Name: mitomycin Brand […]
Medicare Requirement with Acupuncture Services
Posted on February 10, 2021
CMS has issued a National Coverage Determination that covers acupuncture services for chronic low back pain. If you or anyone in your practice is contracted to treat Health New England Medicare Advantage members and is licensed to practice acupuncture, please notify us if you haven’t done so already. If you are not familiar with the […]