Posted on December 5, 2018
Health New England is encouraging Medicare Advantage members to schedule their 2019 Annual Wellness Visit or Physical Exam. Both visits are $0 copay visits for Health New England Medicare members. The following is a guideline on the HCPCS codes: *The emphasis of these Preventive Visits will be on prevention and screening, NOT detection and diagnosis. […]
Posted on December 5, 2018
Health New England has partnered with the Alzheimer Association to provide additional resources and services to those taking care of loved ones with Alzheimer’s disease and other related dementias. In 2019, the caregivers of our Medicare members with Alzheimer’s disease or other related dementias can be referred to this organization to participate in a care […]
Posted on December 4, 2018
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 drug and any drug-specific medication management requirements, including quantity limitations, step therapy requirements and prior authorization requirements. Most […]
Posted on December 4, 2018
Effective 1/1/19, Admelog vials and pens are now our preferred insulin. BeHealthy Partnership members currently using Humalog or Novolog products will need to change over to Admelog or obtain a prior authorization. A letter was recently sent to high utilization providers and noted in the November provider communication.
Posted on December 4, 2018
Health New England’s Clinicial Policies on the Provider Resources page at healthnewengland.org/Providers/Resources have been updated. Most recently, the following policies have been released and/or reviewed: Optune Device (Tumor Treatment Fields-TTF) (UM659POL) Home Health Care Services (UM670POL) Bronchial Thermoplasty (UM661POL) Corneal Cross-Linking (UM671POL) Outpatient Physical and Occupational Therapy (UM376POL) Medicaid Utilization Management Decisions (MH-UM038POL) Artificial Intervertebral […]
Posted on November 26, 2018
The following chart defines the changes to the BeHealthy Partnership/Medicaid prescription drug coverage, effective 1/1/2019. These changes are included in members’ coverage notices. Step Therapy Drug changes effective January 1, 2019: For Health New England to cover the Step Therapy drugs listed here, you first must try the corresponding First Line drugs. If Health New […]
Posted on November 26, 2018
It is Health New England’s policy to conduct its business in compliance with all applicable federal and state laws and regulations and to assure that Health New England operates in a manner consistent with the letter and the spirit of the laws. Health New England expects its employees, management, governing body members and first tier, […]
Posted on November 20, 2018
In our continued effort to go green, we have a created a new section: Coding Best Practices & Tips at healthnewengland.org/providers/coding. The goal of this new section is to provide helpful tips around documentation and coding, guidance on prior authorization, as well as awareness around compliance. As part of our effort to not fill your […]
Posted on November 20, 2018
As of 1/1/19, Inflectra will replace Remicade as the new preferred product for Health New England. This change affects our Commercial and Medicaid members. Members currently on Remicade will be required to try Inflectra (first-line) and Renflexis (second-line) before they can continue Remicade. Prior approval through MagellanRx is required on all three of these products. […]
Posted on November 20, 2018
As part of our commitment to provide affordable access to high quality health care, Health New England continually reviews benefits and services offered to our members. As a result, from time to time, we update the coverage we provide and change the way coverage is administered. View Amendment >