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 […]
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 […]
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 […]
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: […]
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.
Posted on May 4, 2020
Effective, March 1, 2020. This policy is located at healthnewengland.org/providers/resources. In this policy, we provide guidance around documentation and billing, and we reference our Evaluation and Management payment policy to help you understand the codes.
Posted on May 4, 2020
At Health New England, we try our best to provide guidance on coding best practices. Due to COVID-19, we recently added the following “State of Emergency” tip sheets to communicate how we are following guidance from the Centers for Disease Control and Prevention (CDC), Centers for Medicare & Medicaid Services (CMS), the Division of Insurance, […]
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 6/1/2020 Chondrocyte Transplant to the Knee • Added 4 definitions • Updated criteria “For Approval” with adds, deletes and clarifications • Updated “What is Not […]
Posted on March 12, 2020
Effective May 12, 2023 – Changes to Over-the-Counter COVID-19 Test Kit Coverage Health New England covered the costs of FDA-authorized, rapid, at-home COVID-19 tests and will continue to cover until the end of the public health emergency (PHE), which will end on May 11, 2023. Any reimbursement requests for test kits purchased before May 12, […]
Posted on February 10, 2020
Attention Practice Managers: Accurate provider/pharmacy directories are critical to helping our members make educated decisions about their plan choices. Health New England offers an online directory for all of our products. In addition, hard copies of each directory are available upon request. In an effort to support both CMS and NCQA requirements, we reach out […]