Category Archives: Provider Newsletter

COMING SOON: Home & Outpatient International Normalized Ratio (INR) & Prothrombin Time (PT) Monitoring Services

Posted on December 16, 2019

Beginning January 1, 2020, coding and reporting guidelines on International Normalized Ratio (INR) and Prothrombin Time (PT) for anticoagulation management can be found at healthnewengland.org/provider. Click on Coding Best Practice and read up on “Home & Outpatient International Normalized Ratio Monitoring Services.” INR/PT allows a physician to determine the level of anticoagulation (also called blood […]

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Medicare Advantage and Qualified Medicare Beneficiary (QMB) Program

Posted on December 16, 2019

The Qualified Medicare Beneficiary (QMB) Program is one of the four Medicare Savings Programs that allows Enrollees to get help from the state to pay Medicare premiums and cost sharing. Some Health New England Medicare Advantage members have this benefit, and the Federal law prohibits Medicare providers from collecting coinsurance, copayments and deductibles from those […]

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Interpreter Services for Medicaid Members (Reminder

Posted on December 16, 2019

As a reminder, some of our Medicaid members may be limited in English proficiency and by law have rights mandated by Mass.gov under the Limited English Proficiency laws. If you are caring for one of our Medicaid members members, you are required by MassHealth regulations to provide interpreter services so the member can receive the […]

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December 2019 Clinical Review Criteria

Posted on December 16, 2019

Health New England’s Clinical Policies have been updated and can be found on the Provider Resources page at healthnewengland.org/providers/resources. On the Resources page, click on “Behavioral Health/Medical Policies” to learn of the changes. Reviewed with Changes effective 1/1/20 Drug Testing (communicated change in November communication) Medical Policies Reviewed with Changes effective 2/1/20 Artificial Intervertebral Cervical […]

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Payment Policy – November 2019 Update

Posted on November 18, 2019

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 – click into the Payment Policies section. Most recently, the following policy has been released and/or reviewed: Urine Drug Testing

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Claims Edit Reminder

Posted on November 18, 2019

Health New England has an automated review of claims against accepted industry rules and coding guidelines. The sources for coding rules and edits may include, but are not limited to, the following: CPT, ICD, CMS and Health New England Payment Policies. This automated update and review takes place quarterly. For more information on the guidelines […]

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Urine Drug Testing (UDT) – effective January 1, 2020

Posted on November 18, 2019

Health New England understands urine drug testing is medically necessary and plays an integral role in effective medical management of opioids. It should also be used appropriately to inform clinical decision making. Health New England reimburses for covered, medically necessary drug testing services as defined in our Clinical Review Criteria for Drug Testing guidelines available […]

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Code of Conduct, Reporting Issues, Annual Training

Posted on September 27, 2019

Reporting Concerns: All Covered Individuals are required to promptly report potential compliance, or fraud, waste and abuse (FWA) issues of which they have knowledge or a good faith belief. Report in one of the following ways: a) Report to Health New England Compliance: compliancedepartment@hne.com. b) Call the Health New England Compliance hotline toll-free at (800) […]

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Reminder: eviCore – Prior Authorization Required

Posted on September 27, 2019

A recent assessment of our system identified some sleep DME, genetic testing and high cost imaging codes paying without a prior authorization. Our system has since been corrected. To ensure your claims pay accordingly, you should always reference eviCore’s managed code list. You can do this by going to www.eviCore.com or www.healthnewengland.org/providers, click Learn More […]

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Reminder: American College of Radiology (ACR)

Posted on September 27, 2019

Quality of care for our members is a priority. This is why we require ACR accreditation when performing high cost imaging services. When the accreditation evaluation is complete or when you renew, a certificate is awarded to you. As a reminder, this certificate is as important to Health New England and our Care Management Solutions vendor, […]

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