Provider News
March 2017 - In this issue:
 Meeting
Upcoming Regional Provider Meetings
  
NHP Provider Relations is hosting a series of regional provider meetings across Massachusetts to review the latest news and updates from NHP. Topics include: system enhancements, referral/authorization process updates, the latest news on NHP programs, and much more. Upcoming meetings in March will be held in Waltham and Lowell. RSVP today:
 

Waltham

Date: Wednesday March 15, 2017
Time: 12:00-1:30 PM (Lunch will be served)
Location:  The Westin Waltham
70 Third Avenue
Waltham, MA 02451
RSVP: Click Here
    

 
Lowell

Date: Friday March 17, 2017
Time: 11:30-1:00 PM (Lunch will be served)
Location:  Lowell Community Health Center
161 Jackson Street
CHEC Training Room (6th Floor)
Lowell, MA 01852
RSVP: Click Here
    
  auth
In-Network Prior Authorizations
  
As a reminder, NHP recently implemented a system enhancement to allow all in-network authorization requests to now be submitted online through NHPNet. Services that will move from a fax submission process to an online submission process include: 
  • Acupuncture
  • Ambulance - Non Emergent
  • Botox
  • BRCA Testing
  • Dermatology
  • Neuropsych Testing
  • Vascular Surgery Services
  • Weight Management
  • Wound Care

Starting on 4/1/17, NHP will no longer accept fax submissions for in-network authorization requests. Out-of-network authorization requests must still be faxed to NHP. 


 

How to Enter Outpatient Prior Authorizations

To submit an outpatient prior authorization, follow these steps: 

  1. Click on the "Submit New Request" button in the Authorization section of NHPNet
  2. Select "Outpatient" from the authorization type drop-down list
  3. Complete all required fields

Note: Select the appropriate service from the Requested Service drop-down list. Acupuncture and Non-Emergent Transportation have been added to the list. If the service is not listed in the drop-down list, select "Other Medical"

For more information, the Outpatient Authorization User Guide has been updated is now available. 


    

Upcoming Webinar Trainings

RSVP today to attend an upcoming training to review the authorization submission process. Click on the corresponding link to RSVP:

  coversheet
Submitting Clinical Documentation
  
For the fastest processing time, clinical information should always be uploaded directly to your authorization in NHPNet.
  
Faxing clinical documentation often takes longer to process as it is a manual process to find and match the fax to appropriate authorization. To improve processing times for faxes, NHP recently adopted a new fax technology that integrates faxed clinical documentation with your online authorization request. To start using this new capability today, simply print an authorization-specific coversheet generated when you submit authorization online and include it with your fax. Effective May 1, 2017, an authorization-specific coversheet must be used when faxing clinical documentation.  Click Here for instructions on the clinical fax process.  
  
Clinical Fax Webinar
The next webinar training to review the clinical fax process is Wednesday March 8, 2017 (12:30-1:00 PM).
Click Here to RSVP today.

  PEP
Provider Enrollment Portal
  
As regulations around data integrity become tighter, your responsibility of managing your roster and ensuring that health plans have your latest information is important more than ever. NHP recently launched a new comprehensive online management system to support your provider roster requests. In addition to the following capabilities, you will have the ability to generate a completed HCAS form that can be sent to other health plans:
  • Enroll new providers to your group
  • Terminate existing providers
  • Open and close panels
  • Submit demographic changes
  • Check the status of your online requests
  • Receive email notifications when requests are completed 

Training Webinar

The next webinar to review the new Provider Enrollment Portal is Tuesday March 21, 2017 (2:00-3:00 PM). Click Here to RSVP today. 

 

  forms
Imaging Services and Medication Standardized Prior Authorization Forms
  
Last year, the Mass Collaborative, which includes NHP along with other health plans, clinicians, and hospitals, developed three standardized prior authorization forms for imaging services and one standardized prior authorization form for prescription drugs requests (excluding hepatitis C treatments and Synagis): 
  • Medications
  • Cardiac Imaging (Myocardial Perfusion Imaging "MPI", Stress Echocardiogram, Multiple Gated Acquisition Scan "MUGA", Transthoracic Echocardiogram "TTE", and Transesophageal Echocardiogram")
  • PET - PET CT
  • CT/CTA/MRI/MRA
The Division of Insurance issued this bulletin requiring health plans and providers to use these forms when faxing prior authorization requests.  
  
Click Here to access the standardized imaging forms.
Click Here to access standardized medications form.


Submitting Imaging Services Prior Authorization to eviCore   
NHP is partnering with eviCore Healthcare for utilization management of imaging services. Providers can submit requests to through eviCore's website. Fax requests should be completed on the appropriate standardized prior authorization form and faxed to eviCore at 888-693-3210.

 
Submitting Pharmacy Prior Authorization Forms to CVS/caremark
NHP is partnering with CVS/caremark for utilization management of medication prior authorization requests. Completed medication prior authorization forms should be faxed to CVS/caremark at: 


 
Non-Specialty Drug Request Fax Numbers:

  • MassHealth: 866-255-7569
  • Commercial: 888-836-0730
  • Qualified Health Plan: 855-245-2134

 

Specialty Drug Request Fax Number:

  • All Products: 866-249-6155
asthma
Asthma Care Management Program
  
NHP's Asthma Care Management Program focuses on making an Asthma Care Manager available to the patient and improving our members' understanding of asthma and how to control it for optimal results. Available education materials include asthma equipment guides and asthma assessment guides. Visit nhp.org for more information.

Please note: NHP no longer distributes supplies to members through our Asthma Care Management Program. This includes supplies such as mattress/pillow covers, air purifiers, vacuum cleaners, and HEPA filters. 

  

 mpr 
Medical Policy Updates 
 
The following are medical policy updates effective 4/1/17:
  • Infertility Services (All Products):
    • Revised Overview Section language indicating:
      NHP only provides coverage for IVF medications (Follistim AQ, Gonal-F RFF, Menopur, Novarel, Ovidrel, and Pregnyl) if the IVF or medicated IUI services have been approved.
    • Added another IVF coverage criteria                             

B.       Single Embryo Transfer (SET):                              

a.    NHP requires SET for the first two IVF cycles when at least 2 good-quality embryos are available at the time of transfer for females <35 years of age;

b.    NHP requires SET for the first IVF cycle when at least 2 good-quality embryos are available at the time of transfer for females age 35-37;

c.     NHP does not require SET for a female over the age of 37;

    • Added exclusion:
      38. Coverage of IVF medications if the IVF or medicated IUI services are not approved.
    • Added definition of SET:
      SET: Transfer of a single embryo at either the cleavage stage (day 2 or 3 after an egg retrieval) or blastocyst stage (day 5 or 6 after an egg retrieval), that is selected from a larger number of available embryos.
Click Here to view all medical policies.  
  code
Coding Updates
  
Effective April 15, 2017, the following codes will not be payable for all lines of business (Commercial and MassHealth). CPT codes for the administration of vaccines should be used:
  • G0008 - Administration of influenza virus vaccine
  • G0009 - Administration of pneumococcal vaccine
  • G0010 - Administration of hepatitis B vaccine
  
Effective April 15, 2017, the following codes will not be covered for all lines of business (Commercial and MassHealth):
  • 86910 - Blood typing, for paternity testing, per individual; ABO, Rh and MN
  • 86911 - Blood typing, for paternity testing, per individual; each additional antigen system
  
The following genetic testing codes are considered experimental/investigational. Effective April 15, 2017, these codes will not be covered for all lines of business (Commercial and MassHealth):
  • 81227 - CYP2C9 (cytochrome P450, family 2, subfamily C, polypeptide 9) (eg, drug metabolism), gene analysis, common variants (eg, *2, *3, *5, *6)
  • 81291 - MTHFR (5,10-methylenetetrahydrofolate reductase) (eg, hereditary hypercoagulability) gene analysis, common variants (eg, 677T, 1298C)

Unlisted Codes
As a reminder, NHP does not accept claims for services reported using unlisted, not otherwise classified (NOC) or not otherwise specified (NOS) codes. Valid CPT or HCPCS codes should always be used to report all services. Services that do not have valid CPT or HCPCS codes are often non-covered.
  
Claims billed with unlisted, NOC or NOS codes will deny. If you believe that a denied code is a covered service and no other valid code describes the service, supporting clinical documentation will be required to be submitted.

  oon
Out-of-Network Services
  
As a reminder, NHP does not cover or reimburse for non-emergent services rendered to an out-of-network provider without an approved prior authorization. For non-emergent care such as laboratory services, always use or refer members to an NHP-contracted provider.  Click Here to access NHP's Authorization Guidelines for more information.

On behalf of all of us at Neighborhood Health Plan, we thank you for the excellent care provided to our members and the continued collaboration extended to our staff.
 
Thank you,

 
Helen Connaughton 
Director of Provider Relations