October 2021 – Formulary Update
Posted on September 30, 2021
Health New England’s formularies are located at healthnewengland.org. At the top of the page, use the “Find A Drug” tool.
ProviderMatters
Provider Directory Validation and CAQH Initiative
Posted on September 30, 2021
Attention Providers and Practice Managers: Accurate provider directories are critical to helping our members make educated decisions about their plan choices. Health New England offers an online directory for all products, and hard copies of each directory are available upon request. In an effort to support Centers for Medicare & Medicaid Services (CMS), MassHealth, The […]
EOHHS Updates
Posted on September 30, 2021
In partnership with the Executive Office of Health and Human Services (EOHHS), we have been asked to share the following: • The My Account Page in the Virtual Gateway is now read-only. You are no longer able to update information on the page. • Recent announcement regarding the mandates of the COVID-19 vaccine for Long […]
Early Intensive Behavioral Intervention Services
Posted on September 30, 2021
Early Intensive Behavioral Intervention Services (EIBI) is a treatment based on the principles of applied behavior analysis (ABA). The treatment offers someone who is diagnosed with autism the opportunity for improved learning, skill development and behavior changes. When a Health New England member requires this type of treatment, a prior authorization is required. However, the […]
Colorectal Cancer Screening
Posted on September 30, 2021
Age limit lowered to 45 (Commercial Members) Recently, the U.S. Preventive Services Task Force (USPSTF) lowered the recommended age for colorectal cancer screening from 50 to 45, expanding the range to 45 – 75 years. With that said, effective January 1, 2022, Health New England recommends and will cover the screening of all Fully Insured […]
October 2021 Payment Policies
Posted on September 30, 2021
Health New England is committed to reviewing our internal procedures and define coverage and billing guidelines with applicable laws and industry standards to ensure our policies are appropriate. To access payment policies, please visit healthnewengland.org/Providers/Resources. The following policy was created: COVID-19 Vaccination – documented current procedures The following policies were reviewed and updated: Claims Editing […]
Aunt Bertha
Posted on September 30, 2021
Social Assistance/Community Services for our Members Health New England, in partnership with our parent company Baystate Health, is now able to provide a resource to connect our members facing social needs to programs that serve them. We can do this with dignity and ease. Effective November 1, 2021, your patients, our members facing social needs, […]
Site of Service Program (Magellan)
Posted on September 30, 2021
As you know, Health New England informed our network back in 2019 that we would begin a Site of Service program through Magellan. At the time, the program was volunteer-based. In the most recent August 2021 notice, we shared with you that certain infusions and injectable drugs would now be required in a home location. […]
End of State of Emergency – COVID Coverage
Posted on September 30, 2021
On June 15, 2021, Governor Baker ended the state of emergency here in Massachusetts, and many of the public health mandates required since March 2020 have ended or been modified. Since the risk of COVID-19 transmission is still prominent, Health New England will continue to cover the testing, treatment and vaccinations as described below: COVID […]
Coverage of PANS/PANDAS
Posted on September 30, 2021
Massachusetts Department of Insurance (DOI) Bulletin 2021-06 Per state mandate (Chapter 260, Acts of 2020), and effective for Commercial Fully Funded plans that are issued or renewed on or after January 1, 2022, Health New England is required to provide coverage for the treatment and diagnosis of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections […]