Category Archives: Provider Newsletter

May 2019 Clinical Review Criteria

Posted on May 28, 2019

Health New England’s Clinicial Policies have been updated and can be found on the Provider Resources page at healthnewengland.org/Providers/Resources. Most recently, the following policies have been released and/or reviewed: Medical: Spinal Cord Stimulation (UM300POL) Preimplantation Genetic Testing (PGT) / Preimplantation Genetic Diagnosis (PGD) (UM481POL) Therapeutic Shoe and Orthotic Coverage (UM340POL) Speech Therapy for Autism Disorders […]

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Provider Update – April 2019

Posted on April 3, 2019

Dear Providers: We are happy to share with you the enclosed April 2019 update related to various Health New England programs and changes that may have an impact on your patients and/or your practice. On a regular basis, Health New England reviews our clinical criteria for our Behavioral Health and Medical policies as well as the […]

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Claims Edit Reminder

Posted on April 2, 2019

As a reminder, 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 […]

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New Autism Professional Services Codes Coming Soon

Posted on April 2, 2019

Attention Behavioral Health Providers: Recently, the American Medical Association (AMA) announced changes to how Adaptive Behavior Services (ABA) will be billed in 2019, but will allow payers to implement on various schedules. Health New England has made a decision to implement these changes effective June 1, 2019. What you can expect with this change: Some […]

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April Payment Policy Update

Posted on April 2, 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. Most recently, the following policies have been released and/or reviewed: Bilateral and Multiple Professional and Facility Services Neuropsychological and Psychological Testing

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Claims Edit

Posted on January 8, 2019

As you may or may not know, 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 […]

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Provider Directory Validation

Posted on January 8, 2019

Attention Practice Managers: Accurate provider/pharmacy directories are critical to helping our members make educated decisions about their plan choices. Health New England offers an online directory for all of our products. In addition, hard copies of each directory are available upon request. In an effort to support both CMS and NCQA requirements, we reach out […]

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eviCore Update

Posted on January 8, 2019

With the new year upon us, this is when most updates take place. Please note that eviCore is updating its prior authorization list, and starting January 1, 2019, you will need to reference the Lab Grid as additional updates will take place. As always, if you have questions, please call your Provider Relations team at […]

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Medicare Part D – New Opioid Prescribing Policy

Posted on January 8, 2019

Recent guidance on safe use of Opioid pain medication for Medicare Part D patients was released from the Centers for Medicare & Medicaid Services (CMS). Please see the enclosed policy. If there are specific questions, please feel free to reach out to our Pharmacy team at (413) 787-4004. Effective January 1, 2019.

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