Provider News
November 2017 - In this issue:
 Product
2018 Commercial Product and Benefit Updates
  
Acupuncture Benefit for Select Large Group Plans
Starting on 1/1/18, select HMO and PPO Plus large group plans will have a new benefit design which will include coverage for acupuncture. 

Members in plans that include an acupuncture benefit will have no copay for the first 6 acupuncture visits, and will be covered for up to 20 total visits.  Prior to the service, please remember to always verify benefits and copay information for commercial members by contacting NHP Provider Service at providerservice@nhp.org or 855-444-4647.

The following are covered acupuncture codes for commercial plans that include an acupuncture benefit:
  • 97810 - Acupuncture, 1 or more needles; without electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
  • 97811 - Acupuncture, 1 or more needles; without electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s) (List separately in addition to code for primary procedure)
  • 97813 - Acupuncture, 1 or more needles; with electrical stimulation, initial 15 minutes of personal one-on-one contact with the patient
  • 97814 - Acupuncture, 1 or more needles; with electrical stimulation, each additional 15 minutes of personal one-on-one contact with the patient, with re-insertion of needle(s) (List separately in addition to code for primary procedure)
PPO Plus
Our new PPO product, PPO Plus, will be available to small and large employer groups as early as January 1, 2018. For in-network coverage, PPO Plus members will have access to NHP's PPO network, as well as MultiPlan's PHCS Healthy Directions providers when the member is outside NHP's service area. For greater flexibility, PPO Plus members have the option to see out-of-network providers at a higher cost share. 

For more information, a PPO Plus Fact Sheet is available for your reference. Training opportunities will be scheduled in December to review 2018 NHP product updates. Stay tuned! 

6-Tier Prescription Drug Program
To help address the rising costs of specialty medications, we've created new 6-tier Rx plans that will be available starting 1/1/18. This new 6-tier formulary provides more value to employers and members by breaking out specialty medications into two tiers, with lower cost sharing for preferred specialty medications than non-preferred specialty medications. Here's how NHP will define our FlexRx 6 tier plans:
  • TIER 1 (low-cost generic) includes lower cost generic medications. Generic medications contain the same active ingredients as their brand name counterparts
  • TIER 2 (generic) includes higher cost generic medications
  • TIER 3 (preferred brand name) includes preferred brand name medications
  • TIER 4 (non-preferred brand name) includes non-preferred brand name medications
  • TIER 5 (preferred specialty) includes preferred specialty medications as specified by NHP
  • TIER 6 (non-preferred specialty) includes non-preferred specialty medications as specified by NHP
MA Health Connector Open Enrollment
The 2017-2018 open enrollment period to purchase insurance through the Health Connector runs from November 1, 2017 through January 23, 2018. 

  CME
Reminder: Online Trainings Are Now Available For Free CME and MOC Credits!
  
As the end of the year approaches, we know that some providers still need to meet their Continuing Medical Education (CME) and Maintenance of Certification (MOC) requirements for the year. We'd like to remind you of 2 free, online trainings for CME and MOC program credits for physicians that we are currently offering. These trainings are available to all NHP Providers. Please share this information with the clinical staff in your practice.   

Substance use Disorders (SUDs) and Medication Assisted Treatment (MAT) for Opiates
This activity is a free, online training which will be available from July 1st, 2017, through June 30th, 2018. Each eLearning module is 45 minutes in duration; this includes 30 minutes for the presentation and 15 minutes to complete the tests and evaluation. During this webinar, the presenter will provide a comprehensive overview of the rising importance of MAT in the fight against opioids. In addition, the presenter will review the different medications used as well as their benefits and contraindications... More information.




Treating Patients with Depression Using Coordinated Medication Management
This activity is a free, online training which will be available from July 1st, 2017, through
June 30th, 2018. Each eLearning module is 45 minutes in duration; this includes 30 minutes for the presentation and 15 minutes to complete the tests and evaluation. During this webinar, the presenter will provide a comprehensive overview of the appropriate diagnosis of depression and the use of standardized screening tools. In addition, the presenter will review the options for medication management of depression in a primary care setting... More information.



   PandT
NHP P&T Updates 

The Pharmacy and Therapeutics Committee has reviewed and updated medications for January. Click Here to access NHP's formulary updates effective 1/1/18. 
   Novo
Medical Specialty Drug Updates Effective 1/1/18

Drugs Requiring Prior Authorization Through CVS Caremark (all NHP lines of business):
  • Adagen
  • Aldurazyme
  • Aralast NP
  • Aranesp (Albumin Free)
  • Arcalyst
  • Aveed
  • Cerezyme
  • Elaprase
  • Elelyso
  • Epoprostenol Sodium
  • Exondys 51
  • Fabrazyme
  • Flolan
  • Glassia
  • HP Acthar
  • Kanuma
  • Leukine
  • Lumizyme
  • Mircera
  • Myozyme
  • Ocrevus
  • Procrit
  • Prolastin-C
  • Remodulin
  • Somavert
  • Synagis
  • Veletri
  • Vpriv
  • Xolair
  • Zemaira

Infusion Drugs Reviewed For Site of Care (NHP commercial HMO and PPO and Health Connector members only):
  • Aldurazyme
  • Aralast NP
  • Cerezyme
  • Elaprase
  • Elelyso
  • Fabrazyme
  • Glassia
  • Lumizyme
  • Prolastin-C
  • Vpriv
  • Zemaira
How To Submit Prior Authorization For These Drugs?
Submit your prior authorization requests to CVS Caremark via fax at 844-851-0882 or phone at 844-345-2803.

For additional information, visit   www.nhp.org/medicalspecialtydrugs.
   Code
Code Updates and Reminders

New October 2017 Codes
The following HCPCS codes are covered with prior authorization effective 10/1/18:
  • C9491 - Injection, avelumab, 10 mg
  • C9492 - Injection, durvalumab, 10 mg
  • C9493 - Injection, edaravone, 1 mg
  • C9494 - Injection, ocrelizumab, 1 mg
Reminder: Status B Codes
Incidental global procedures are procedures that clinical practice standards suggest are normally included as a part of the definitive procedure and would not be separately reimbursed. CMS refers to these procedures as 'Status B' codes. All codes defined by CMS as 'Status B' will be denied as such by NHP and are not considered separately reimbursable. 

Click Here to view the General Coding and Billing payment policy guideline. 

   PEP
Use The Provider Enrollment Portal To Keep Your Practice Information Up To Date

NHP recently launched an enhanced provider directory to help patients easily search for and connect to available clinicians in their area. As NHP continues to be one of the fastest growing commercial health plans in the state, its important more than ever to have your practice accurately reflected in our directory to avoid unnecessary patient calls to your office. 

For example: If you are not currently taking new patients, let us know that your panel is closed so that new patients won't try to schedule an appointment. If your panels become open, an accurate display in the directory will make your practice accessible to our growing commercial population, which grew over 50% in the past 3 years! 

With NHP's Provider Enrollment Portal, updating your practice information has never been so easy! NHP's Provider Enrollment Portal gives you easy access to the following capabilities:
  • Enroll new providers into your group
  • Terminate existing providers who leave your practice
  • Open and close your panels
  • Submit demographic changes 
  • Check the status of requests submitted through the Provider Enrollment Portal
  • Receive email notifications when your online requests are completed
  • Generate and print a completed HCAS form that can be sent to other health plans!
Contact us today at prweb@nhp.org for more information on how to get access to the Provider Enrollment Portal.

   LateBilling
Reminder: Late Charge Billing

Any charge not included on the original claim is considered a late charge. Currently, late charges can be submitted on a UB04. As we've heard from providers, this can sometimes generate duplicate payments in error.

To improve the provider experience, NHP will be implementing a new process for late charge billing. Beginning December 1, 2017, all late charge billing must be submitted to NHP as a corrected claim containing all charges, including those previously billed. This improved front-end process will eliminate duplicate payments and any retractions required for overpayments.

   evicore
eviCore Web Portal Enhancement

eviCore recently enhanced their web portal to now allow you to submit clinical online. Login to www.evicore.com and follow the clinical upload instructions to upload clinical directly to your authorization. 

The clinical upload enhancement also allows you to submit additional clinical without logging in to your account. Click Here for instructions. 

   medicalpoly
Medical Policies
  
The following medical policy updates are effective November 1, 2017:
  • Insulin Pumps (All Products) - Annual review without substantial changes in medically necessary indicators. 
  • Continuous Glucose Monitors (All Products) - Annual review without substantial changes in medically necessary indicators. 
Click Here to view all medical policies. 
    paperless
Reminder: Provider Notifications to Go Paperless!

Through recent provider satisfaction surveys and feedback, we've heard from you that paper mailings don't always reach the appropriate staff. To improve your experience, NHP's primary way to send provider notifications will be through email. In addition to improving the timeliness of receiving notifications, email notifications are environmentally friendly!   

To ensure that you and your staff are included on NHP email notifications, register for NHPNet today. A summary of important n ews and updates will also be included in NHP's monthly provider eNewsletter. Click Here to start receiving the eNewsletter. 

We will be implementing this process in the Fall. Please share this information with your staff. 

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