ProviderMatters

Clinical Review Criteria Update – Preimplantation Genetic Testing for Monogenic/Single Gene Defects (PGT-M)

Posted on March 30, 2021

Policy Number: UM481POL Effective Date: 6/1/2021 LOB Affected: Commercial Policy Type: Medical Title of Policy changed: From:  Preimplantation Genetic Testing (PGT) / Preimplantation Genetic Diagnosis (PGD) To:  Preimplantation Genetic Testing for Monogenic/Single Gene Defects (PGT-M) Definitions:  Eliminated Preimplantation Genetic Diagnosis (PGD) Added under Preimplantation Genetic Testing for Aneuploidy (PGTA): Not covered by HNE Removed definition of PGT-A […]

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Formulary Update – February 2021

Posted on February 10, 2021

Health New England’s formularies can be accessed on healthnewengland.org using the “Find A Drug” tool at the top of the page. Brand Name: Asceniv Generic Name: immune globulin Brand Name: Darzalex Faspro Generic Name: daratumumab-hyaluronidase FIHJ Brand Name: Evomela Generic Name: melphan Brand Name: Hemady Generic Name: dexamethasone Brand Name: Jelmyto Generic Name: mitomycin Brand […]

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Medicare Requirement with Acupuncture Services

Posted on February 10, 2021

CMS has issued a National Coverage Determination that covers acupuncture services for chronic low back pain. If you or anyone in your practice is contracted to treat Health New England Medicare Advantage members and is licensed to practice acupuncture, please notify us if you haven’t done so already. If you are not familiar with the […]

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Qualified Medicare Beneficiary (Reminder)

Posted on February 10, 2021

Qualified Medicare Beneficiary (QMB) is a benefit that pays Medicare premiums and cost sharing for certain beneficiaries. Some Health New England Medicare Advantage members have this benefit, and Federal law prohibits Medicare providers from collecting coinsurance, copayments and deductibles from those enrolled in this program. Recently, CMS asked organizations to inform providers if a member […]

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Automatic Blood Pressure Monitor (A4670)

Posted on February 10, 2021

As Health New England works with our network of providers to improve the health and lives of our members, we have made changes to requirements on the Automatic Blood Pressure Monitor through Northwood, our durable medical equipment benefit manager. Effective 1/8/2021, the Medical Necessity Determinations on Automatic blood pressure monitor (A4670) for Commercial and Medicaid […]

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Educational Resource

Posted on February 10, 2021

Health New England recently updated the Provider Resources page at https://healthnewengland.org/Providers/Resources with a new Skilled Nursing and Rehabilitation Facilities Guide. A copy of this booklet has been sent to the Skilled Nursing Facilities in our network.

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Clarification on changes with 99072

Posted on February 10, 2021

In our December notification, we informed you of changes with CPT code 99072, effective March 1, 2021. To clarify, beginning March, this code will be considered part of the office visit service and will not be reimbursed separately. For any questions, please do not hesitate to call your Provider Relations Representative at (800) 842-4464, extension […]

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Clinical Review Criteria – February 2021

Posted on February 10, 2021

Health New England’s Clinical Policies have been updated and can be found at healthnewengland.org/Providers/Resources Once on the Resources page, click on Behavioral Health/Medical Policies to learn of the changes. *Please note, new/revised policies may not appear until closer to the effective date. Reviewed and Updated (Effective date of 4/1/2021) Gender Reassignment Surgery • Updated “Required […]

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Provider Update – Special Edition January 2020

Posted on January 5, 2021

Medical Policy Updates (New Category 1 Codes added) Health New England’s Clinical Policies have been updated. While the criteria has not changed, the policies now include the most up-to-date coding information. These policies can be found at healthnewengland.org/providers/resources. Once on the Resources page, click on Behavioral Health/Medical Policies to learn of the changes. The following […]

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