Posted on January 5, 2021
Medical Policy Updates (New Category 1 Codes added) Health New England’s Clinical Policies have been updated. While the criteria has not changed, the policies now include the most up-to-date coding information. These policies can be found at healthnewengland.org/providers/resources. Once on the Resources page, click on Behavioral Health/Medical Policies to learn of the changes. The following […]
Posted on December 28, 2020
Effective January 1, 2021, there are changes to policies and procedures for newborn members: eligibility, enrollment and payment. It is important to know and understand these changes, especially for hospitals delivering these infants. An example of one of the changes is when a baby is born, the hospitals have 10 days to submit a Notice […]
Posted on December 18, 2020
(Population health management for chronic kidney disease (CKD) or end-stage renal disease (ESRD)) As of December 2020, Health New England and Healthmap Solutions, Inc. (Healthmap) began working together to provide care coordination services for Medicare Advantage members with chronic kidney disease (CKD) or end-stage renal disease (ESRD). To learn more, please go to https://healthnewengland.org/Providers/Resources and […]
Posted on December 18, 2020
(Durable Medical Equipment Benefit Manager) Northwood, our durable medical equipment benefit manager, has updated their managed code listing as of January 1, 2021. 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 […]
Posted on December 18, 2020
(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, […]
Posted on December 18, 2020
Health New England continues to allow clinically appropriate and medically necessary telehealth services with our in-network providers through the state of emergency. We shared earlier that we will waive member cost-sharing for COVID-19 and non-COVID-19 related medically necessary telehealth services.* This decision to waive member cost-share has been extended until March 31, 2021, for most […]
Posted on December 18, 2020
Effective March 1, 2021, Heath New England will no longer cover CPT code 99072 * for additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other non-facility service(s), when performed during a Public Health Emergency, as defined by law, due to respiratory-transmitted infectious disease. *As summarized […]
Posted on December 14, 2020
Health New England’s formularies can be accessed on healthnewengland.org using the “Find A Drug” tool at the top of the page.
Posted on December 14, 2020
Health New England is committed to review our internal procedures and define coverage and billing guidelines with industry standards to ensure our policies are current. To access payment policies, please visit healthnewengland.org/Providers/Resources. The following will be new effective 1/1/2021 Skilled Nursing Facility (documents current procedures)
Posted on December 14, 2020
For our BeHealthy Partnership members and others utilizing MassHealth with their benefits, Health New England follows the guidance provided by the Executive Office of Health and Human Services (EOHHS). Below is a reminder from their recent Bulletin that we are following: Bulleton 301: Impact of COVID-19 on Behavioral Health and the Importance of Perinatal and […]