Posted on February 10, 2021
Qualified Medicare Beneficiary (QMB) is a benefit that pays Medicare premiums and cost sharing for certain beneficiaries. Some Health New England Medicare Advantage members have this benefit, and Federal law prohibits Medicare providers from collecting coinsurance, copayments and deductibles from those enrolled in this program. Recently, CMS asked organizations to inform providers if a member […]
Posted on February 10, 2021
As Health New England works with our network of providers to improve the health and lives of our members, we have made changes to requirements on the Automatic Blood Pressure Monitor through Northwood, our durable medical equipment benefit manager. Effective 1/8/2021, the Medical Necessity Determinations on Automatic blood pressure monitor (A4670) for Commercial and Medicaid […]
Posted on February 10, 2021
Health New England recently updated the Provider Resources page at https://healthnewengland.org/Providers/Resources with a new Skilled Nursing and Rehabilitation Facilities Guide. A copy of this booklet has been sent to the Skilled Nursing Facilities in our network.
Posted on February 10, 2021
In our December notification, we informed you of changes with CPT code 99072, effective March 1, 2021. To clarify, beginning March, this code will be considered part of the office visit service and will not be reimbursed separately. For any questions, please do not hesitate to call your Provider Relations Representative at (800) 842-4464, extension […]
Posted on February 10, 2021
Health New England’s Clinical Policies have been updated and can be found at healthnewengland.org/Providers/Resources Once on the Resources page, click on Behavioral Health/Medical Policies to learn of the changes. *Please note, new/revised policies may not appear until closer to the effective date. Reviewed and Updated (Effective date of 4/1/2021) Gender Reassignment Surgery • Updated “Required […]
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, […]