Attention Providers: News Regarding our Medication Prior Authorization Forms December 30, 2011
Posted by mhumel2 in : Notice of Policy Changes , add a commentPlease note that there have been changes made to our Medication Prior Authorization forms pertaining to where the form should be faxed. For the most updated Medication Request Forms please visit our online drug look-up.
http://hne.com/HNE_Pharmacy/formulary.html
Attention Be Healthy Providers December 27, 2011
Posted by mhumel2 in : Notice of Policy Changes , add a commentBelow is a message from the MA Department of Public Health/WIC regarding a recent change to the state contract formula:
As of October 1st Massachusetts WIC changed the state contract formula from Nestle /Gerber Good start/Good Start Soy to Enfamil PREMIUM Infant and Enfamil ProSobee formulas. These formulas will no longer be identified as special formulas requiring medical documentation. We have also added /changed a few Non-Contract formulas to the WIC formulary. I have attached the MA WIC formula listing for you to share with the appropriate staff/providers as these changes will affect the types of prior approvals that will be requested from medical providers.
Many of our local programs have recently reported when the MassHealth/WIC participant’s medical provider request Gentlease or Enfamil A.R. through MassHealth’s PCCP or MCO’s the DME (Denmark)/MCO has informed the MassHealth/WIC member to go back to WIC for these formulas. Enfamil Gentlease and Enfamil A.R. are non-contract formulas on WIC and will be treated as any other special formula. The local WIC programs will continue to guide the MassHealth/WIC participant back to the members plan to submit a prior authorization for any metabolic, or non-contract formula.
WIC will continue to provide the 1st month of formula, until the prior authorization is approved.
New Pharmacy Initiative Effective 1/1/2012 December 16, 2011
Posted by mhumel2 in : Notice of Policy Changes , add a comment*This announcment does not apply to Medicare Advantage or Be Healthy members.
HNE wants you to be aware of a Pharmacy Initiative that will be in place for January 1, 2012.
We are encouraging members currently taking brand name proton pump inhibitors (PPI’s) such as Aciphex, Dexilant, Nexium, Prevacid, and Protonix to switch to a generic equivalent. As part of this initiative HNE will be waiving the Tier 1 copay for omeprazole capsules and pantoprazole from January 1, 2012 to April 1, 2012. We estimate that by switching from higher tiered PPIs to these tier 1 generics, members can save up to $630 in out of pocket costs each year (savings can vary based on the member’s plan). Members are under no obligation to switch,and this program is voluntary.
A letter will be dropping in the mail this week to affected members and providers. If you have any questions, please contact Provider Relations at 800-842-4464, extension 5000.
Semi Annual Notice of Changes December 15, 2011
Posted by mhumel2 in : Notice of Policy Changes , add a comment
As part of our commitment to provide affordable access to high quality health care, we continually review the benefits and services offered to our members. As a result, from time to time we update the coverage we provide and change the way that coverage is administered. We then notify our members, their employers, our brokers, and our contracted providers of these changes. If you have any questions, please call the Provider Relations Department at 413-787-4000 or 800-842-4464, ext 5000.
We have attached a copy of an amendment to the HNE Explanation of Coverage.
Fully Funded Semi Annual Notice of Changes 1-2012
Attention HNE Be Healthy Providers December 9, 2011
Posted by mhumel2 in : Notice of Policy Changes , add a commentPlease click the link below to see a recent message from MassHealth regarding fluoride varnish for members age 6 months through 21 years.
Why Consider Fluoride Varnish in the Medical Setting
Provider Technology Adoption Survey December 7, 2011
Posted by mhumel2 in : Notice of Policy Changes , add a commentPlease click on the link below to read the HealthCare Administration Solutions (HCAS) announcement regarding this survey.
HCAS New Project Announcement 11 28 11
Mercy Medical Center Joins HNE’s Medicare Advantage Provider Network October 17, 2011
Posted by mhumel2 in : Notice of Policy Changes , add a commentPlease see attached Press Release:
Press Release-Mercy Medical Center in HNE Med Adv Network (2)
Mobile ID Card Survey: We want to hear from you! September 8, 2011
Posted by mhumel2 in : Notice of Policy Changes , add a commentThe app will also include functionality to transmit a copy of the ID card to your office electronically, via fax or e-mail.
http://www.jotform.com/form/12505709943
Attention Behavioral Health Providers September 8, 2011
Posted by mhumel2 in : Notice of Policy Changes , add a commentAttached please find our new Inpatient Psychiatric/Acute Residential Treatment (ART) Crisis Stabilization Unit (CSU) Clinical Review Form.
Inpt Psych-ART-CSU Clinical Review Form
New Universal “Request for Claim Review Form” June 29, 2011
Posted by mhumel2 in : Notice of Policy Changes , add a commentIn our ongoing effort for administrative simplification for Providers, we are pleased to share with you the form that will replace the current HNE Provider Appeal form, On Time Corrected Claim form and Coordination of Benefits form. The “Request for Claim Review” form has been approved by 7 health plans to help provider offices streamline their processes. Please begin using this form immediately. You can access the form on HNE.com. This form can be faxed to 413-233-2797 or mailed to One Monarch Place, Suite 1500, Springfield, MA 01144-1500.
The health plans that will be using this form are Blue Cross Blue Shield of Massachusetts, Fallon Community Health Plan, Harvard Pilgrim Health Care, Neighborhood Health Plan, Network Health, Tufts Health Plan and HNE.