Step Therapy Drug Changes Effective July 1 Commercial Members
Posted on May 28, 2021
ProviderMatters
Health New England Risk Adjustment Data Validation Audit (RADV)
Posted on May 28, 2021
Please note, due to the COVID-19 pandemic, there will be two Risk Adjustment Data Validation Audit (RADV) projects performed in 2021. The Centers of Medicare and Medicaid Services (CMS) conduct these validations. Health New England is currently collecting records for dates of service in 2019 for our Commercial Members. The request for dates of service […]
Health New England Risk Adjustment Partnering With Pulse8
Posted on May 28, 2021
Health New England Risk Adjustment Department is partnering with Pulse8, our new risk adjustment platform. Pulse8 will be utilizing Episource on our behalf to retrieve medical records. Starting in May 2021, there will be two projects for our Medicare Advantage members. The first project is a continuation of record request for 2019 dates of service […]
Wellness Services – Acupuncture
Posted on May 28, 2021
Effective July 1, 2021, Health New England updated benefits for our Fully Funded Commercial members as follows: Health New England covers up to 12 visits per calendar year for acupuncture. Our members must receive in-plan services from an Optum Physical Health acupuncturist. Our members can find an in-plan provider in HNE’s provider directory, and they […]
Preventive Services
Posted on May 28, 2021
Under the Affordable Care Act, Health New England must provide coverage for preventive services to our Commercial members. Preventive services are health services necessary for our members to maintain their health and well-being, and include services like routine physical exams or immunizations, screening, and certain pediatric and prenatal services. To learn more about what services […]
Prior Authorization Requirements (Reminder)
Posted on May 28, 2021
When a service requires a Prior Authorization (PA) per our Behavioral Health/Medical Policies, it is the responsibility of all those involved in providing the service to verify that PA has been obtained. Not obtaining or verifying a PA on these services can result in denial of payment. This applies to all those rendering services or […]
Nutritional Counseling Benefit
Posted on May 28, 2021
Health New England offers a nutritional counseling benefit to our Commercial Fully Funded Members. With this benefit, a Prior Authorization is not required for these members, but there are limitations with visits. For this benefit, we approve our member for 4 visits per calendar year. We will not authorize visits beyond this timeframe. When a […]
835 Enhancement to Send Checks and Electronic Payments
Posted on May 28, 2021
Effective 6/15/2021, to meet compliance requirements, Health New England has enhanced the 835-transaction BPR segment. This enhancement allows us to send checks (CHK) as well as electronic payments (ACH) in BPR04. To learn more about all the corresponding elements required in the BPR segment, please go to healthnewengland.org/Providers/Resources and click HIPAA Transactions to locate the […]
Coming Soon ProgenyHealth
Posted on May 28, 2021
Health New England, in support of our continued effort to improve the health and well-being of our members, is pleased to announce a partnership with ProgenyHealth, a company specializing in Neonatal Care Management Services throughout the first year of life. Effective 7/30/2021, ProgenyHealth’s Neonatologists, Pediatricians and Neonatal Nurse Care Managers will begin working closely with […]
Telehealth Guidance Location 02
Posted on May 28, 2021
When providing care to our members, whether in person or by way of telehealth, it is important to remember to include the appropriate location of these services in your claim submission. This may result in a separate claim submission for those in-person type services ordered during a telehealth office visit. If the services, which are […]