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 […]
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 […]
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 […]
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 […]
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 […]
Posted on May 28, 2021
Effective 8/1/2021, Health New England has decided, for our Commercial members, that HCPCS code L8699, Prosthetic Implants, not otherwise specified,* will no longer be separately reimbursed and the prior authorization requirement removed. If this code is used, you will see a denial stating covered services bundled into payment. For more information, go to healthnewengland.org/Providers/Resources, click […]
Posted on May 28, 2021
Health New England is committed to reviewing our internal procedures and defines 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 reviewed and updated: Unlisted Procedures & Services
Posted on May 28, 2021
Health New England continues to allow clinically appropriate and medically necessary telehealth services with our in-network providers through the state of emergency. However, effective 7/1/2021, we will resume applying member cost sharing for non-COVID-19 related medically necessary telehealth services.* *Some self-funded employer groups do not participate in Health New England’s Teladoc benefit and decided not […]
Posted on May 28, 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 May 28, 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. To view all of June 2021 clinical policies updates, click here.