Formulary Update – June 2020
Posted on June 2, 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
Coding Best Practices – June 2020
Posted on June 2, 2020
Health New England continues to provide helpful tips which can be found in our Coding Best Practice section on www.healthnewengland.org/provider/resources. Most recently we updated the COVID-19 II Physician Tip Sheet as well as added two new tip sheets on telehealth: Medicare Annual Wellness Visits via Telehealth Coding and Billing Telehealth Services for Medicare Advantage (coming […]
Experimental and Investigational Codes – June 2020
Posted on June 2, 2020
Effective 8/1/2020, Heath New England considers the following codes to be experimental and investigational and will be non-covered: Code Description 97607 Negative pressure wound therapy, (eg, vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wound(s) […]
Clinical Review Criteria – June 2020
Posted on June 2, 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. MEDICAL POLICIES: Updated Policies Effective 8/1/2020: Biofeedback for Urinary Diagnoses Orthognathic Surgery Rhinoplasty Adopted InterQual criteria InterQual criteria is available upon request Bone Grafts for Spinal […]
Primary Care Provider Feedback – Behavioral Health Survey
Posted on May 4, 2020
It’s important for Health New England to hear from our Primary Care Providers on the care of your patients as it relates to behavioral health. Your insights allow us to continually strive to provide the best experience with patient care. With our go-green efforts, you will find an online survey for you to share your […]
Request for Claims Review Determination Time Frame – May 2020
Posted on May 4, 2020
As most know, every provider has a right to request a review of their claims payment if they disagree. Here at Health New England, we allow you to submit a request for review 12 months from the date of service or date of discharge for inpatient services. We do ask for a Request for Claim […]
Provider Claims Servicing Unit Hours – May 2020
Posted on May 4, 2020
Beginning May 1, 2020, our Provider Claims Servicing Unit, which answers general claims inquiries, will be available between the hours of 8:00 a.m. and 5:00 p.m. until further notice. They can be reached at (800) 842-4464, ext. 5026. For more specific education, review of complex claims, or reimbursement, please continue to call Provider Relations at […]
Clinical Review Criteria – May 2020
Posted on May 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. Effective 7/1/2020: Infertility Treatment – Specific to limitations for embryo transfers • Members of any age will be required to follow ASRM (American Society for Reproductive […]
Formulary Update – April 2020
Posted on May 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. Brand Name: Aklief cream Generic: Trifarotene Brand Name: Baqsimi Generic: Glucagon nasal Brand Name: Doptelet Generic: Avatrombopag Brand Name: Fibryga Generic: Fibrinogen Brand Name: Gvoke Generic: Glucagon SQ Brand Name: Harvoni pellets Generic: […]
Pharmacy Prior Authorization – April 2020
Posted on May 4, 2020
Health New England is working to identify and extend certain prior authorizations (PA) for drugs that are due to expire in the coming weeks. Health New England anticipates that, where appropriate, these existing prior authorizations will be extended for at least another 60 days.