Posted on July 2, 2020
Per CMS guidelines, as well as to ensure claims payment, it is important that all components of the Part D claim form are filled out completely. In addition, we are asking that all Part D vaccine claim forms be sent to the following address: All Med D OptumRx Manual Claims P.O. Box 650287 Dallas, TX […]
Posted on July 2, 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 the end of 2020 […]
Posted on July 2, 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 are reminders from their recent Bulletins that we are following: MassHealth’s Bulletin 25: Effective April 1, 2020, a single nasal package consists of two nasal […]
Posted on July 2, 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 July 2, 2020
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.* MEDICAL POLICIES: Updated Policies Effective 9/1/2020 Knee Braces • Definition changes with Prefabricated Braces Changed From: Prefabricated Braces: (L1810-L1833, L1836, L1843, L1845, L1847, L1850 and L1852) […]
Posted on June 2, 2020
Step Therapy Drug changes effective July 1, 2020: For Health New England to cover the step therapy drugs listed here, you first must try the corresponding first line drugs. If Health New England has paid a claim for the first line drug within the previous 180 or 360 days (depending on the first line drug), […]
Posted on June 2, 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 June 2, 2020
Health New England continues to provide helpful tips which can be found in our Coding Best Practice section on www.healthnewengland.org/provider/resources. Most recently we updated the COVID-19 II Physician Tip Sheet as well as added two new tip sheets on telehealth: Medicare Annual Wellness Visits via Telehealth Coding and Billing Telehealth Services for Medicare Advantage (coming […]
Posted on June 2, 2020
Effective 8/1/2020, Heath New England considers the following codes to be experimental and investigational and will be non-covered: Code Description 97607 Negative pressure wound therapy, (eg, vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wound(s) […]
Posted on June 2, 2020
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. MEDICAL POLICIES: Updated Policies Effective 8/1/2020: Biofeedback for Urinary Diagnoses Orthognathic Surgery Rhinoplasty Adopted InterQual criteria InterQual criteria is available upon request Bone Grafts for Spinal […]