Posted on July 18, 2019
Health New England’s commitment to providing quality care to our members also requires us to meet obligations set forth by regulatory organizations such as the Centers for Medicare & Medicaid Services (CMS), the National Committee for Quality Assurance (NCQA) and Department of Insurance (DOI). These organizations require health plans to maintain up-to-date provider directory information […]
Posted on July 18, 2019
As a reminder, when recommending Cologuard to your patients, Health New England requires a prior authorization through eviCore for our Commercial and BeHealthy Partnership members. The prior authorization must be obtained prior to ordering the test. For our Medicare Advantage members, no prior authorization is needed through the end of 2019. For more information on […]
Posted on July 18, 2019
The Group Insurance Commission (GIC) plan year began July 1, 2019, and you will see the following changes with copays: Specialist copay – only two tiers Tier 1 ($30) – applies to specialists who are NOT affiliated with an Academic Medical Center* Tier 2 ($60) – applies to specialists who ARE affiliated with an Academic […]
Posted on July 18, 2019
Health New England’s formularies can be accessed on healthnewengland.org using the “Find A Drug” tool at the top of the page. The online formularies are updated throughout the year as changes are made. We have three formularies, one for each line of business – Commercial, Medicare Advantage and BeHealthy Partnership/Medicaid. Each formulary includes the tier […]
Posted on July 18, 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. Medical Policies – Changes – Effective 9/1/19 Total Hip Resurfacing Bone Grafts for Spinal Defects Sacroiliac Joint Fusion for the Treatment of Adult […]
Posted on June 27, 2019
Health New England is in the process of changing our Electronic Data Interchange (EDI) transaction process effective August 15, 2019. In order to ensure there is no disruption with claims payment, we are reaching out for the name, email address and phone number for your EDI manager or someone within your Information Technology department who […]
Posted on June 27, 2019
On Saturday, July 13, 2019, Health New England will be performing some system maintenance which will bring all of our external facing digital solutions down. This includes HNEDirect and healthnewengland.org. The system will be brought down at 4:00 a.m. and will resume connectivity by 5:00 p.m. However, throughout the day, there is a chance you […]
Posted on May 28, 2019
Step Therapy Drug changes effective July 1, 2019: For BeHealthy Partnership to cover the Step Therapy drugs listed here, you first must try the corresponding First Line drugs. If BeHealthy Partnership has paid a claim for the First Line drug within the previous 180 or 360 days (depending on the First Line drug), then you are eligible […]
Posted on May 28, 2019
Health New England’s formularies can be accessed on healthnewengland.org using the “Find A Drug” tool at the top of the page. The online formularies are updated throughout the year as changes are made. We have three formularies, one for each line of business – Commercial, Medicare Advantage and BeHealthy Partnership/Medicaid. Each formulary includes the tier assignment for each […]
Posted on May 28, 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 quarterly. For more […]