March 2016
nhp.org/provider
Provider News 
Claims
Reminder: Claim Processing Enhancements          
 
NHP is dedicated to ensuring that your claims are always processed accurately and timely, and we constantly look for ways to enhance the experience for our providers. In 2015, claims process enhancement initiatives included:
  • Pre-Payment Claim Edits - To reduce the overall number of claim adjustments after you receive payment, NHP is looking for opportunities to move certain claim edits from post-payment to pre-payment.
  • Correct Claims Submission Process - As a result of being incomplete or illegible, we have seen handwritten claims contribute to slower processing times and payment errors. NHP now requires that all corrected claims be typed, computer generated, or electronically submitted.
Original Claim Submission Process Update
To align with the corrected claims submission process, NHP will implement an update to the original claims submission process. Effective March 1, 2016, all original claims must be typed, computer generated, or electronically submitted. Original claims that are handwritten will not be processed. 
SurgicalAuth
Surgical Authorization Submissions           

Servicing Provider Field

Currently, for inpatient and outpatient surgical authorizations, the surgeon's name and NPI are entered in the Remarks field. As of April 1, 2016, the requesting provider must enter both the facility and the specialist into the Servicing Provider field. This will automatically generate separate prior authorization numbers to the facility and to the specialist, and ensure that the corresponding claims appropriately match. 



Submitting Surgical Requests
As a reminder, surgical authorization requests must be submitted by the rendering specialist. Surgical authorization requests initiated by the patient's Primary Care Provider (if the Primary Care Provider is not performing the surgery) will be closed and will not be processed. 

For additional information, please see our Inpatient and Outpatient Authorization User Guides:
Surgical Authorization Request Webinars
To support you with this change, NHP Provider Relations and Clinical staff are hosting a series of webinars to review the process. To attend this webinar, RSVP by clicking on the appropriate link below.
 
Date: March 22, 2016
Time: 12:30pm -1pm
RSVP:  Click Here

Date: March 24, 2016
Time: 12pm - 12:30pm
RSVP:  Click Here

Date: March 30, 2016
Time: 12pm - 12:30pm
RSVP: Click Here
SNF
Post Acute Facility Authorizations               

 

We are excited to announce the availability of the new Post Acute Facility Authorization Request Form for your submissions of clinical documentation. This form can be accessed in the Provider Forms section of nhp.org.

As a reminder, initial and concurrent review requests must be submitted through NHPNet, the secure provider portal. Click Here to view the authorization submission user guide. To support the review process, please enter clinical documentation onto the new Post Acute Facility Authorization Request Form and upload the form to the NHPNet authorization. If you are unable to upload this form to NHPNet, you may fax this to 617-586-1700.

Post Acute Facility Authorization Webinar
To support you with the authorizations, NHP Provider Relations and Clinical staff are hosting a webinar training to review the authorization submission process. To attend this webinar, RSVP by clicking on the link below:

Date: March 22, 2016
Time: 11am-12pm
RSVP: Click Here
 
NPT
Universal Neuropsychological Assessment Form                
 
The Mass Collaborative recently developed a universal form for neuropsychological assessment prior authorization requests. This form is now available in the Forms section of nhp.org/provider. Starting May 1, 2016, all requests for neuropsychological assessments with a medical diagnosis must be submitted on this form and faxed to NHP at 617-586-1700.  


Beacon1
The fight to combat opioid addiction continues
 
Last summer, Gov. Charlie Baker called for the inclusion of physicians as "full-fledged partners" with the state in its fight against an opioid crisis that claimed more than 1,000 Massachusetts lives in 2014. There is still more work to be done. The number of overdose deaths resulting from the usage of opioids, which include both prescription painkillers and heroin, continues to climb. In Massachusetts, opioids now kill more people than car accidents and guns combined.
 
Responding to the governor's call, Neighborhood Health Plan (NHP) and its behavioral health partner, Beacon Health Options (Beacon), are working to address this crisis in Massachusetts. In brief, these initiatives manage change across every point in the care process, from preventing addiction, to improving care pathways, to innovating methods of payment and treatment. Those efforts for 2016 are described in more detail below.

  • Prevention: Quarterly, Beacon's Prescribing Dispensing and Analysis Report (PDAR) analyzes member, prescriber, and pharmacy data to identify high-risk members. This report provides both detail as well as summary information regarding members and prescribers medication-related behavior, which helps to facilitate early interventions. For example, NHP connects high-risk individuals with social workers to improve their access to supportive resources, such as outpatient recovery programs, housing and transportation.
  • Improvement of clinical models: Beacon is piloting new ways to improve the clinical model for substance use disorder care. For example, in a partnership with two Boston-area treatment centers, Beacon is piloting a clinical program to help members access medication-assisted treatment on the same day as their discharge from opioid detoxification programs. By doing so, members' chance of relapse is greatly reduced. NHP is also piloting a program that connects recovery coaches with members who have recently suffered from an overdose.
  • Aligning payment with value: Beacon is also exploring new ways to pay for substance use disorder care, recognizing that opioid addiction is a chronic, rather than episodic, illness. Specifically, Beacon is partnering with both clinical and academic experts at a western Massachusetts provider and Harvard Business School to develop a value-based payment for opioid use disorders.

 

Providers who would like information regarding additional resources available to members who are struggling with addiction should contact Beacon at (800)414-2820. You may also access a white paper that Beacon wrote on the subject, " Confronting the Crisis of Opioid Addiction ", available on Beacon Lens.
evicore
eviCore healthcare 2016 Guidelines
 
eviCore healthcare is announcing the launch of the 2016 Radiology & Cardiology Guidelines. The forthcoming guidelines represent an extensive harmonization process that resulted in three fundamental enhancements:
  • Guidelines are condition-based, not procedure-based;
  • Inclusion of dedicated pediatric guidelines; and
  • A single core set of guidelines.
The guidelines will become effective on Friday, March 18th, 2016. They have been published to   www.eviCore.com and can be accessed here:  2016 eviCore Radiology & Cardiology Guidelines- Effective 03-18-2016.
Postpartum
Postpartum Visit Scheduling Resources

 
Did you know that NHP offers free resources to support best practices for perinatal care? A routine postpartum visit is recommended between 21 and 56 days following delivery. For a complimentary postpartum appointment scheduling tool and HEDIS tip sheet, visit the Maternal-Child Health page of nhp.org. You can download printable PDFs or place an order to have copies sent right to your office. You can also find information on, "For You Two," NHP's prenatal care management program for members at high risk for adverse birth outcomes, as well as links to our other Care Management programs. 


Thank You! 

 

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.  

 
Helen Connaughton
Director of Provider Relations  
Neighborhood Health Plan