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Neighborhood Health PlanMay 18, 2017
Discover why more membersare choosing NHP
NHP ProductsNHPProductNameNHP ConnectLine of Business NHP PrimeMassHealthQualifiedHealth Plan(QHP)StandardCommonHealthCarePlusFamily Assistancevia Health Connector(Commercial) HMO ConnectorCareCommercialvia Direct Market HMO PPO
Commercial ID Card NHP Prime HMO– Green Banner NHP Prime PPO– Green Banner– PHCS Logo(upper right hand corner)
Qualified Health Plan NHP Prime HMO– Green Banner– MA Health Connector Logo
MassHealth ID Card NHP Connect– Blue Banner
2017 Pharmacy CopaysNHP Prime plans (Commercial and QHP) for individuals, families, andsmall businesses now waive the copays for 11 common medications forchronic conditions
Verifying Eligibility Always verify member eligibility prior to rendering care Qualified Health Plan (QHP) members:– Required to pay monthly premiums through the Health Connector– For non-payments, members have a 3-month grace period: Month 1 – Active eligibility, claims process normally Months 2 & 3 – Eligibility will appear as “Active – PendingInvestigation”, claims will pend
Temporary MassHealth EnrollmentFreeze of New NHP Members NHP has been the fastest growing MCO in Massachusetts We continue to experience material losses in the MassHealth line ofbusiness After considering many other options to address this situation, NHPand MassHealth implemented a temporary enrollment freeze for newMassHealth members joining NHP This option ensures no disruption for our existing MassHealthmembers.
Authorization and Referrals All authorizations can now besubmitted electronically throughNHPNET This will increase transparencywith authorization request andstatus
Network Trainings and Webinars Over 3,100 providers participated in anNHP webinar in 2016 We will continue to expand offerings in2017 Webinar included topics such asauthorization updates and new providertechnology demos We hope that your staff can join anupcoming training (future trainings willbe announced in the newsletter andNHPNet)
Provider eNewsletter The provider eNewsletter is acentral place to get the latestnews and updates from NHP Includes both important clinicaland operational updates Sign up today onNHP.org/provider
NHPNet Questions For all your questions related to NHPNet access or theauthorization/referral submission process, please email:prweb@nhp.org
DRG/EAPG We are currently working on transitioning hospitals onto DRG/EAPGmethodology More information to come! If you have any questions, contact Provider Services
Claims Process RemindersAppeals and Claims Correspondence: Fax Number: 617-526-1902 NHP’s new address:399 Revolution Drive Suite 940Somerville, MA 02145 Do not send correspondence to the PO Box addressSome simple claims adjustments or questions: Email: providerservice@nhp.org Call: 855-444-4647
Electronic Funds TransferStop receiving paper checks!NHP has partnered with Change Healthcare tosimplify EFT registration & paymentRegister on Change Healthcare’sProviderNetYou will need the following information: Your organization’s NPI & Federal Tax ID Your bank/financial institution’s routingnumber & your account number A recent check from NHPRegister today at: https://providernet.adminisource.com
MassHealth Coverage NHP now aligns coverage of codes for our MassHealth line of businesswith MassHealth’s payment guidelines NHP will only reimburse for services that MassHealth determines arepayable Coverage for some 2017 codes are currently being determined byMassHealth Refer to MassHealth payment guidelines for the latest information(subchapter 6 in MassHealth’s Provider sshealth/providerlibrary/provider-manual/
Coming Soon! NHP’s EnhancedProvider Directory NHP is launching a new online provider directory this summer New user-friendly interface to help members easily search ourprovider networks, as well as other enhanced capabilities Stay tuned for more information!
Provider Enrollment Portal NHP now offers a new self-service online provider enrollmentmanagement tool through NHPNet Ability to track request status and receive email notification whenrequests are completed Online Requests include:– Enroll new providers to your group– Terminate existing providers– Open and close PCP panels– Submit demographic changes After you submit an online request, an HCAS form can be auto-generatedfor you to send to other health plans Contact prweb@nhp.org for questions and to get access today!
Provider Enrollment Portal
Contacting NHPProvider ServicesProvider Servicesproviderservice@nhp.org1-855-444-4647(M-F 8 a.m.-6 p.m.)NHPNet SupportProvider Enrollment& Credentialingprweb@nhp.orgpec@nhp.org
Thank you!
prweb@nhp.org . DRG/EAPG We are currently working on transitioning hospitals onto DRG/EAPG methodology More information to come! If you have any questions, contact Provider Services . Claims Process Reminders . Appeals and Claims Correspondence: Fax Number: 617-526-1902 NHP’s new address: 399 Revolution Drive Suite 940 . Somerville, MA 02145 Do not send File Size: 831KBPage Count: 22
