Home

Providers

Quick Links

Healthwise® Care Support Pages

Search over 400 simple patient education sheets on a variety of health topics by category or key terms (available in English & Spanish).

Provider News and Updates

Update: Effective August 1, 2013

Payment Policy Changes

To better align with local and national industry standards and to support our mission of offering affordable high quality care for diverse communities, we are issuing the following payment policy changes:

After Hours Code Add on Code (99051)
Bundled Codes/Services
High Tech Radiology Codes

To read the full notice about these changes, please click here.

Update: Effective February 1, 2013

Important Update to February 1, 2013 NDC Coding Requirement

NHP will reject claims that do not meet the following requirements for NHP Mass Health members only. Providers will need to submit claims for HCPCS on this list with both HCPCS and NDC codes to NHP with the exact NDC that appears on the medication packaging in the 5-4-2 digit format (i.e. xxxxx-xxxx-xx). NHP will continue to accept NDC for all lines of business. As a reminder, if you have a bundled rate or global fee arrangement for outpatient claims with NHP then your claims will be accepted without NDC codes.

Additional Details

Neighborhood Health Plan will require the 11-digit National Drug Code (NDC), NDC units and unit descriptors on outpatient claims for drugs administered during a patient's visit in addition to the HCPCS code in order to be compliant with the State regulations.

For services provided as of February 1, 2013, outpatient claims that include physician-administered drugs will need to be submitted with the appropriate NDC information. Mass Health claims submitted without the applicable NDC information will be rejected and subject to re-filing and timely filing limits.

At this time, MassHealth is requiring NDC information on all Single-Source Drugs as defined by CMS, with the exceptions listed below:

Inpatient Claims
Outpatient claims that are part of a bundled rate or global fee
Radiopharmaceuticals
Contrast media
Vaccines
340B program drugs

340B Program Information

Please note that the MassHealth requirement to include NDC information for drugs purchased through the 340B program does not apply to MCO drugs at this time. To indicate that the drug was purchased through the 340B program, providers must add "Modifier UD" with the HCPCS code.

If you have additional questions about filing claims using the NDC number, please read MassHealth's NDC and HCPCS Frequently Asked Questions at http://www.mass.gov/eohhs/gov/newsroom/masshealth/providers/national-drug-code-ndc-requirements-for-html.

Updates: Effective December 1, 2012

Prior Authorization Changes

NHP has removed the prior authorization requirements for the following services:

Outpatient and home Occupational Therapy (OT)
Outpatient and home Physical Therapy (PT)
Outpatient and home Speech Therapy (ST)
Most Surgical Day Care (SDC)

NHP members with an HVMA PCP seeking outpatient or home-based PT/OT/ST services from a non-HVMA provider will continue to require authorization. Please verify benefits prior to rendering services.

For a complete listing of services that require prior authorization and/or referrals, please reference the Provider Authorization Grid.

Urine Drug Testing Payment Guideline Revised

NHP's Urine Drug Testing (UDT) Provider Payment Guideline has been revised. Please read the provider notice regarding this change and other important billing information.

Changes: Effective January 1, 2013

(New) Durable Medical Equipment (DME) Prior Authorization Changes Don Changes NHP has completely realigned the prior authorization requirements for many Durable Medical Equipment (DME) codes resulting in a significant reduction of DME items which require prior authorization.

Access the list of DME items that will continue to require authorization effective January 1, 2013.