September 2016
nhp.org/provider
Provider News 
 Webinar 
Update: New Go-Live Date and Webinar Schedule for Authorization & Referral System Enhancements  
  
NHP is dedicated to ensuring an optimal provider experience when requesting authorizations and referrals. To support this effort, NHP is launching several enhancements to our authorization and referral intake system on September 30, 2016 (previously scheduled for September 1). These enhancements will result in a more streamlined submission process and improved authorization/claim matching functionality.

Provider webinar trainings have been scheduled to review the new features and how to effectively submit your request. To register, click on the link corresponding to the session you would like to attend:
MH
MassHealth MCO Plan Selection and Fixed Enrollment Period  
 
Currently, MassHealth members who are enrolled in a managed care plan (MCO) may change plans at any time for any reason. Effective October 1, 2016, MassHealth will begin implementing respective Plan Selection Periods and Fixed Enrollment Periods.

Plan Selection Period - Members enrolled with an MCO will only be able to change MCOs during their annual 90-day Plan Selection Period.

Fixed Enrollment Period
- Once the 90-day Plan Selection Period has ended, members will be in a Fixed Enrollment Period and, except in limited circumstances, members will be unable to change MCOs until their next annual Plan Selection Period. 
 
As a reminder, please remember to always verify eligibility for all patients prior to rendering services.   

Click Here for more information.   

  

  UDT
Urine Drug Testing
 
Services Beyond 20 Dates of Service Within a Benefit Period 
NHP implemented a new payment policy and medical policy for urine drug testing on July 1, 2016. As indicated in the policies, 
greater than 20 dates of service in a benefit period for urine drug testing are generally not considered medically necessary and all submitted claims over 20 dates of service will deny. 

Post-service submission and review of documentation is required for urine drug testing that extends beyond 20 dates of service within a benefit period. Click Here to view the medical policy and a list of documentation requirements
. Submit required documentation to providerservice@nhp.org .  

Note: Prior authorization for urine drug testing is not required, and any authorization requests submitted through NHPNet will not be reviewed. 

Urine Drug Testing Payment Policy
The urine drug testing payment policy was updated on 7/1/16 to reflect that NHP will reimburse presumptive and definitive drug class screenings HCPCS G0477-G0483, for medically necessary urine drug testing services (NHP will reimburse one unit per date of service or per day). NHP does not reimburse presumptive drug testing codes billed with CPT 80300-80304, nor definitive drug testing codes billed with CPT 80320-80377.   

  EI
Experimental and Investigational Services
 
As a reminder, NHP does not cover or otherwise reimburse for experimental/investigational services. Below are important updates and clarifications:

Cologuard
 
For dates of service on or after September 1, 2016, the use of Cologuard for colorectal cancer screening will be reimbursable with an approved prior authorization (subject to medical necessity review by eviCore). Click Here to review the updated clinical guidelines.

Prior Authorization Code List Clarification  
As a reminder, starting on August 1, 2016, prior authorization is required for selected molecular and genetic testing services. This prior authorization is managed by eviCore. Experimental/investigational services are not included on eviCore's lab management prior authorization code list as experimental/investigational services are non-covered. Click Here to view the prior authorization list for lab service.

Services Requiring Prior Authorization through eviCore 
For services requiring prior authorization through eviCore, you can submit requests via:
  WIC
WIC Nutrition Program Update: New Infant Formula Contract 
 
Effective October 1, 2016, Abbott Nutrition will hold the contract to provide standard formula for Massachusetts WIC infants that are not exclusively breastfeeding. Similac Advance and Similac Soy Isomil will be the state contract formulas, replacing Enfamil Infant and Enfamil ProSobee Soy. 

Click Here for more information. 

 

  CDC
CDC Advisory Committee Recommends Against Using FluMist Vaccine        

In June, a Centers for Disease Control and Prevention (CDC) advisory committee recommended that FluMist, the nasal spray influenza vaccine, should not be used during the 2016-2017 flu season. FluMist is an alternative to the standard flu shot for patients between the ages of 2 and 49 years old. Clinical data from previous flu seasons demonstrated ineffective results against the targeted strains. The advisory committee urges providers to continue to stock and provide only the injectable vaccine for the upcoming flu season.

Click Here for more information.  
 
  mpr
Medical Policy Updates 
 
The following medical policy updates include:
  • Home Health Care (All Products) - effective 9/1/16 - Annual review with clarification changes to criteria and exclusions. References updated.
  • Bariatric Surgery (All Products) - effective 9/1/16 - Annual review without substantial changes in medically necessary indicators. References updated. 
  • Breast Surgeries (All Products) - effective 9/1/16 - Annual review without substantial changes in medically necessary indicators. References updated.
  • Enteral Nutrition Formulas & Supplements (All Products) - effective 9/1/16 - Annual review without substantial changes in medically necessary indicators. References updated.
  • Oral Maxillofacial/Dental Treatment Setting (All Products) - effective 9/1/16 - Annual review without substantial changes in medically necessary indicators. References updated.

Click Here to view all medical policies.  

 


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