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 […]
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 […]