Posted on July 30, 2021
Beginning in October, Health New England’s Member and Provider Services teams will offer a voice-activated, self-service option so providers can quickly obtain benefits, eligibility and claim status. This quick and efficient self-service tool offers direct access to information 24 hours a day, 7 days a week. Similar to how you reach us today, call (413) […]
Posted on July 30, 2021
As a reminder, some of our Medicaid/BeHealthy Partnership members may be limited in English proficiency and, by law, have rights mandated by the Commonwealth of Massachusetts under the Limited English Proficiency laws. If you are caring for one of our Medicaid members, MassHealth regulations requires you to provide interpreter services so the member can receive […]
Posted on June 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 reviewed and updated: Observation Services Payment Policy – Updated Section “Indications for Coverage”, “Commercial” on page […]
Posted on June 30, 2021
Health New England’s formularies are located at healthnewengland.org. At the top of the page, use the “Find A Drug” tool.
Posted on June 30, 2021
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. For a printable PDF version, click here.
Posted on May 28, 2021
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 […]
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 […]
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 […]
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 […]