Prescription Drug Coverage Update – Commercial
Posted on May 28, 2022
The following prescription drug coverage will be effective July 1, 2022, for Health New England Commercial plan members:
ProviderMatters
Formulary Update – June 2022
Posted on May 28, 2022
Health New England’s formularies are located at healthnewengland.org. At the top of the page, use the “Find A Drug” tool.
Clinical Review Criteria – June 2022
Posted on May 28, 2022
Health New England reviews clinical policies and updates accordingly. These policies reside at healthnewengland.org/Providers/Resources. Once on the Resources page, click on Behavioral Health/Medical Policies to learn more. Please note, new/revised policies may not appear until closer to the effective date.
Medicare Supplement: Reminder
Posted on April 26, 2022
Many of our Medicare members are beginning to select our Medicare Supplement plans, and with this opportunity, there are important reminders for providers when our members seek care. Our Medicare Supplement members have Original Medicare as their primary coverage and our plan is a supplement to help cover some leftover balances depending on the plan […]
Formulary: May 2022 Update
Posted on April 26, 2022
Below is some important information regarding Spinraza and Zolgensma and our Commercial Members. Beginning May 27, 2022, Providers will continue to follow Health New England’s process through Magellan, but Accredo Health Services will exclusively distribute Spinraza and Zolgensma. Once the approval has been obtained from Magellan, you may order the medication directly from Accredo at […]
QUICK TIPS FOR PROVIDERS TO HELP IMPROVE CAHPS AND HOS PERFORMANCE RATINGS
Posted on March 21, 2022
As you may know, two different patient satisfaction surveys impact a health plan’s CMS Star ratings: The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey is typically mailed to Plan members from March to June. The Health Outcomes Survey (HOS) is typically mailed to members July through November 2022. EOHHS and CMS have […]
Clinical Review Criteria: April 2022 Update
Posted on March 18, 2022
Health New England reviews clinical policies and updates accordingly. These policies reside at healthnewengland.org/Providers/Resources. Once on the Resources page, click on Behavioral Health/Medical Policies to learn more. Please note, new/revised policies may not appear until closer to the effective date.
Formulary: April 2022 Update
Posted on March 18, 2022
Health New England’s formularies are located at healthnewengland.org. At the top of the page, use the “Find A Drug” tool.
HEDIS (Deadline Coming Soon – April 30, 2022)
Posted on March 17, 2022
The National Committee for Quality Assurance standardized measurement criteria, known as the Healthcare Effectiveness Data and Information Set (HEDIS) is underway. During the month of March, you may have received a letter from Health New England’s Quality Management team requesting copies of medical information. As a reminder, all of the medical information requested is due […]
Birthing Center Member Cost Share
Posted on March 17, 2022
Health New England has added a birthing center to our network. With this addition, we have informed our members that effective July 1, 2022, Member Cost Share for inpatient maternity care will apply to care at an in-plan birthing center. For any questions you may have, please call your Provider Relations Representative at (800) 842-4463, […]