Formulary Update – November 2020
Posted on November 4, 2020
Health New England’s formularies can be accessed on healthnewengland.org using the “Find A Drug” tool at the top of the page.
ProviderMatters
Clinical Review Criteria – November 2020
Posted on November 4, 2020
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. New Medical Policies (Effective 12/1/2020) Azedra (iobenguane I 131) Nodify Lung Nodule Risk Assessment BDX-XL2 (Biodesix, Inc.) New Medical Policy (Effective 1/1/2021) Deep Brain Stimulation Treatment […]
Payment Policy – November 2020
Posted on November 4, 2020
Health New England is committed to review our internal procedures and define coverage and billing guidelines with industry standards to ensure our policies are current. To access payment policies, please visit healthnewengland.org/providers/resources. The following policies were reviewed and clarifications were made: • Diabetic Care Payment Policy o Covered Treatment and Services, clarified covered insulin pumps. […]
Code of Conduct, Reporting Issues, Annual Training
Posted on November 4, 2020
It is Health New England’s policy to conduct its business in compliance with all applicable federal and state laws and regulations and to assure that Health New England operates in a manner consistent with the letter and the spirit of the laws. Health New England expects its employees, management, governing body members and first tier, […]
Claims Editing – November 2020
Posted on November 4, 2020
As you know, the Centers for Medicare & Medicaid Services (CMS) has a process for Medicare coverage determination. This includes National Coverage Determinations (NCDs), which are determined through an evidence-based process. In the absence of a national coverage policy, a service may be covered at the discretion of the Medicare contractor using Local Coverage Determinations […]
New Specialty Partnership – (Coming Soon)
Posted on November 4, 2020
Coming soon, Health New England will be working with Healthmap Solutions, Inc. (Healthmap) to provide care coordination services for Medicare Advantage members with chronic kidney disease (CKD) or end-stage renal disease (ESRD). Healthmap is a growing specialty Population Health Management (PHM) company with an industry-leading Kidney Health Management (KHM) program that will greatly benefit our […]
Pain Management Alternatives
Posted on November 4, 2020
At Health New England, we want our members to know there are alternative methods for managing pain than just simply using medication. While we understand the need for some medication, we want you to be aware of the various options we offer for pain treatment so that you can discuss them with your patients. For […]
2021 Benefit Changes (Commercial & Medicare)
Posted on November 4, 2020
New Commercial Plans and Changes for 2021 Thrive First 500: Members have “first dollar” coverage for the first $500 of most medical services, excluding services that are not subject to deductible like Rx. After the first $500 of services are paid by Health New England, the $3,000 deductible will begin to apply. Once deductible is […]
Taxonomy
Posted on November 4, 2020
Health New England is currently reviewing our claims pricing and payment system. During this review, we identified that the taxonomy field historically has not been filled in correctly by some providers. While we have outreached to those providers directly, we are sending this reminder about the importance of taking action with your EDI or billing […]
Health New England Leadership Changes
Posted on November 4, 2020
Health New England Appoints New President and CEO We are pleased to announce that Richard Swift has been appointed to the role of President and CEO of Health New England. Richard has been serving as Health New England’s Interim Chief Financial Officer since April 2020. He is an experienced Chief Executive Officer and Chief Financial […]