Coverage Determinations with HCPC Codes
Posted on March 31, 2021
In addition, the following coverage determinations apply to these HCPC codes:
ProviderMatters
Endovenous Ablation Therapy of Varicose Veins
Posted on March 30, 2021
Policy Number: UM727POL Effective Date: 6/1/2021 LOB Affected: Commercial, Medicare, Medicaid Policy Type: Medical Definitions: Added 2 definitions: Ablation and Radiofrequency Energy Source/Citation Section: Checked links and added 4 references
Provider Directory Validation and CAQH Initiative
Posted on March 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 […]
Provider Appeals
Posted on March 30, 2021
At Health New England, providers have the right to file an appeal if they disagree with how we processed a claim. If you choose to have a claim payment reviewed, you must do so within 12 months from the date of services or date of discharge for inpatient services. We also ask that you reference […]
April 2021 – Payment Policies
Posted on March 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 reviewed and updated: Evaluation and Management Professional Services (updated II – Consultation Codes section to match current […]
Local and National Coverage Determination Rules
Posted on March 30, 2021
Health New England continues to apply local and national coverage determination editing rules based on CMS policies. It is important when submitting claims to Health New England that you are familiar with the rules. For more information, go to https://www.cms.gov/medicare-coverage-database/indexes/national-and-local-indexes.aspx or https://www.ngsmedicare.com. In the “Continue as Guest” Box, select Part B Provider and your state. […]
Telehealth and Waiving of Member Cost Share
Posted on March 30, 2021
Health New England continues to allow clinically appropriate and medically necessary telehealth services with our in-network providers through the state of emergency. We shared earlier that we will waive member cost sharing for COVID-19 and non-COVID-19 related medically necessary telehealth services.* The waiver of member cost sharing has been extended until June 30, 2021, for […]
Health New England’s Provider Manual
Posted on March 30, 2021
Health New England recently reviewed our Provider Manual. While criteria did not change, we did change how we display the document to make your experience of finding information easier. You can see the changes at healthnewengland.org/provider-manual.
Pharmacy Refill on Prescription Contraceptives (Reminder)
Posted on March 30, 2021
Please be advised, Massachusetts law permits individuals with fully insured commercial health plan coverage to fill up to a 3-month supply on a first-time contraceptive prescription and up to a 12-month supply of prescription contraceptives after the first fill. For more information, go to healthnewengland.org/pharmacy or call your Provider Relations Representative at (800) 842-4464, extension […]
April 2021 – Formulary Update
Posted on March 30, 2021
Health New England’s formularies are located at healthnewengland.org. At the top of the page, use the “Find A Drug” tool.