Formulary Update: October 2023
Posted on September 29, 2023
Health New England’s formularies are located at healthnewengland.org. At the top of the page, use the “Find A Drug” tool.
ProviderMatters
Clinical Review Criteria: October 2023
Posted on September 29, 2023
Health New England reviews clinical policies and updates accordingly. These policies reside at healthnewengland.org/Providers/Resources. Once on the Resources page, click on Behavioral Health/Medical Policies to learn more. For more information, please do not hesitate to call your Provider Relations Representative at (800) 842-4464, extension 5000, or send an email to providerrelations@hne.com.
Clinical Review Criteria: September 2023
Posted on August 31, 2023
Health New England reviews clinical policies and updates accordingly. These policies reside at healthnewengland.org/Providers/Resources. Once on the Resources page, click on Behavioral Health/Medical Policies to learn more. For more information, please do not hesitate to call your Provider Relations Representative at (800) 842-4464, extension 5000, or send an email to providerrelations@hne.com.
Provider Manual Updates
Posted on August 31, 2023
Health New England reviews our Provider Manual regularly and notifies you when there are updates. Most recently, we updated the following sections: Billing and Reimbursement (effective 11/1/2023) Claims Submission and Reimbursement Section – Clarified language with claim submission. Updated filing limits. Coordination of Benefits and Subrogation – Updated filing limit. Appeals (effective 11/1/2023) Claim […]
Payment Policies Update
Posted on August 31, 2023
Health New England is committed to reviewing our internal procedures and defining coverage and billing guidelines with applicable laws and industry standards to ensure our policies are appropriate. To access payment policies, please visit healthnewengland.org/Providers/Resources. The following policies were created: Facility Routine Services, Supplies & Equipment – Effective 11/1/2023 Timely Filing Payment Policy – Effective […]
Timely Filing Requirement Changes
Posted on August 31, 2023
Effective November 1, 2023, Health New England’s filing limits will change unless otherwise noted in your contract. This change will affect the claim submission timeline for all providers doing business with Health New England, except under the Medicare product line. In addition, we will be adjusting some of our filing limits as it pertains to […]
eviCore High-Cost Imaging Authorizations
Posted on August 31, 2023
Effective September 1, 2023, for high-cost imaging authorizations, Health New England and eviCore Healthcare have decided to return to the 60-day period from approval time of authorizations to rendering the services for all lines of business. For more information, please do not hesitate to call your Provider Relations Representative at (800) 842-4464, extension 5000, or […]
Magellan Site of Service Program
Posted on August 31, 2023
Health New England is committed to reviewing our Resource Center to ensure the accuracy of information. The following will be updated: “Magellan Site of Service” at healthnewengland.org/Providers/Resources will be updated to clarify the program is applicable to Fully Funded Commercial Members in both the HMO and PPO benefit plans. For more information, please do […]
CPAP/BIPAP Authorization Management
Posted on August 31, 2023
As a courtesy, we are sharing the following: Effective October 1, 2023, Northwood, our durable medical equipment benefit manager (DBM), will now manage PAP authorizations for Health New England. Previously, Northwood’s DME provider network would work with eviCore on authorizations. Both Health New England and Northwood released notification of this transition to eviCore and the […]
Northwood (Reminder)
Posted on August 1, 2023
Health New England partners with Northwood, Inc., our durable equipment benefit manager, for authorizations. This includes the management of durable medical equipment (DME), medical supplies, prosthetic and orthotic for all our members. It is important to know that timely and complete submission of clinical documentation to support medical necessity is key to receiving faster responses […]