Posted on September 27, 2019
Effective 1/1/2020, the calendar year limit for physical and occupational therapy is changing to a combined 60 visits per calendar year. This calendar year limit change does not apply to services that are part of the home health plan or services provided to treat autism spectrum disorder. Those services require a prior approval. A communication […]
Posted on September 27, 2019
Effective 1/1/20, one of our self-funded employer groups, Baystate Health, will be covering 100% of the cost of the Cologuard test for their employees and NO prior authorization is needed. As a provider, you will need to see your patient’s member ID card to know if a prior authorization is needed prior to ordering the […]
Posted on September 27, 2019
Effective 1/1/20, our Medicare Advantage members will have the opportunity to be referred to Mom’s Meals NourishCare® for complete nutritional meals after discharge from an inpatient hospital stay. Here is how it works: Following a hospital stay, our Care Management team will work with the member to select a meal from available categories such as […]
Posted on September 27, 2019
Health New England’s Clinicial Policies have been updated and can be found on the Provider Resources page at healthnewengland.org/Providers/Resources. On the Resources page, click on “Behavioral Health/Medical Policies” to learn of the changes. Reviewed with changes effective 12/1/2019 Surgical Management of Morbid Obesity Abdominal Panniculectomy Contact Lenses Cochlear Implants and BAHA (Bone Anchored Hearing Aid) […]
Posted on September 27, 2019
Back in May of 2019, we announced Health New England was providing our Fully Funded Commercial members with a new pharmacy savings tool called Rx Savings Solutions. This tool will help these members save money and better manage their prescription costs. If one of our members decides to take the opportunity to save, Rx Savings […]
Posted on September 27, 2019
As part of Health New England’s commitment to provide ways on keeping health care costs down for our members, our Medicare Advantage product line is changing our pharmacy benefits manager from Castia Rx to OptumRx®. Beginning January 1, 2020, OptumRx will administer prescription drug benefits for our Medicare Advantage members. New ID Card Issued to […]
Posted on September 27, 2019
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. Most recently, the following policies have been released and/or reviewed: Reviewed: Transportation Services New: Individual Consideration Services – New (documents current procedure for […]
Posted on September 27, 2019
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. This year, we decided to go green and offer an online survey for you to […]
Posted on July 18, 2019
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. Most recently, the following policies have been released and/or reviewed: Emergency Department Services (documented current process effective 7/1/19)
Posted on July 18, 2019
As you may or may not know, Health New England has an automated review of claims against accepted industry rules and coding guidelines. The sources for coding rules and edits may include, but are not limited to, the following: CPT, ICD, CMS and Health New England Payment Policies. This automated update and review takes place […]