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Neighborhood Health Plan May 18, 2017
Discover why more members are choosing NHP
NHP Products
Line of Business
Product Name
NHP
NHP Connect
MassHealth
NHP Prime
Qualified Health Plan
(QHP) Commercial
• Standard • CommonHealth • CarePlus • Family Assistance
via Health Connector (Commercial) • HMO • ConnectorCare
via 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 Copays
NHP Prime plans (Commercial and QHP) for individuals, families, and small businesses now waive the copays for 11 common medications for chronic 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 – Pending Investigation”, claims will pend
Temporary MassHealth Enrollment Freeze of New NHP Members
• NHP has been the fastest growing MCO in Massachusetts
• We continue to experience material losses in the MassHealth line of business
• After considering many other options to address this situation, NHP and MassHealth implemented a temporary enrollment freeze for new MassHealth members joining NHP
• This option ensures no disruption for our existing MassHealth members.
Authorization and Referrals
• All authorizations can now be submitted electronically through NHPNET
• This will increase transparency with authorization request and status
Network Trainings and Webinars
• Over 3,100 providers participated in an NHP webinar in 2016
• We will continue to expand offerings in 2017
• Webinar included topics such as authorization updates and new provider technology demos
• We hope that your staff can join an upcoming training (future trainings will be announced in the newsletter and NHPNet)
Provider eNewsletter
• The provider eNewsletter is a central place to get the latest news and updates from NHP
• Includes both important clinical and operational updates
• Sign up today on NHP.org/provider
NHPNet Questions
• For all your questions related to NHPNet access or the authorization/referral submission process, please email:
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 correspondence to the PO Box address
Some simple claims adjustments or questions:
• Email: [email protected]
• Call: 855-444-4647
Electronic Funds Transfer Stop receiving paper checks!
NHP has partnered with Change Healthcare to simplify EFT registration & payment
Register today at: https://providernet.adminisource.com
Register on Change Healthcare’s ProviderNet You will need the following information: • Your organization’s NPI & Federal Tax ID • Your bank/financial institution’s routing
number & your account number • A recent check from NHP
MassHealth Coverage
• NHP now aligns coverage of codes for our MassHealth line of business with MassHealth’s payment guidelines
• NHP will only reimburse for services that MassHealth determines are payable
• Coverage for some 2017 codes are currently being determined by MassHealth
• Refer to MassHealth payment guidelines for the latest information (subchapter 6 in MassHealth’s Provider Manuals)
http://www.mass.gov/eohhs/gov/laws-regs/masshealth/provider-library/provider-manual/
Coming Soon! NHP’s Enhanced Provider Directory
• NHP is launching a new online provider directory this summer
• New user-friendly interface to help members easily search our provider networks, as well as other enhanced capabilities
• Stay tuned for more information!
Provider Enrollment Portal
• NHP now offers a new self-service online provider enrollment management tool through NHPNet
• Ability to track request status and receive email notification when requests 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-generated for you to send to other health plans
• Contact [email protected] for questions and to get access today!
Provider Enrollment Portal
Contacting NHP
Provider Services [email protected]
Provider Services
1-855-444-4647 (M-F 8 a.m.-6 p.m.)
NHPNet Support [email protected]
Provider Enrollment & Credentialing
Thank you!
