IMPORTANT INFORMATION REGARDING CMS ELIMINATION OF CONSULT CODES January 21, 2010
Posted by mhumel in : Updates , add a commentFOR MEDICARE ADVANTAGE MEMBERS ONLY: The Centers for Medicare & Medicaid Services communicated to Medicare carriers yesterday that consultation codes (99241-99245 and 99251-99255) have been removed from the Medicare Claims Processing Manual. Effective, Jan. 1, 2010, consult codes will no longer be recognized for Medicare Part B payment.
FOR ALL OTHER HNE HEALTH PLANS: Because the American Medical Association is not eliminating these consult codes, we will continue to accept them for all non-Medicare Advantage plans.
Changes to GIC Member Benefits effective 2/1/10 January 19, 2010
Posted by mhumel in : Notice of Changes , add a commentPlease click on the attachment to see the provider notice regarding changes to the GIC member benefits effective 2/1/10:
gic-2-1-10-changes-provider-mailing
IMPORTANT REMINDER TO GIC TIERED PHYSICIANS! January 19, 2010
Posted by mhumel in : Updates , add a commentLast day to appeal your GIC tier-designation is January 29, 2010. For more information please visit the Massachusetts Medical Society website at:
IMPORTANT CHANGE TO HNE ID CARDS January 7, 2010
Posted by mhumel in : Notice of Changes , add a commentEffective January 2010, any newly issued HNE member id cards will not include the Primary Care Physician (PCP) name and that will be the new process going forward. These new cards will only be issued to new members or if existing members have changes to their plan. Existing members will still be able to use their old ID cards until any change is made to their plan. Please reference HNEDirect or contact Member Services at 800-310-2835 if you need to verify a member’s PCP. If you have any questions, please call 413-233-3313.
IMPORTANT PHARMACY REMINDER EFFECTIVE 1/1/2010 January 4, 2010
Posted by mhumel in : Policy Reminders , add a commentEffective 1/1/10, Prior Approval is required for all brand name drugs if a generic is available (for example, Percocet® and Prilosec®). This also applies to members already taking a brand name with a generic available prior to 1/1/10. A copy of the applicable form is included below:
ps367pol-multisourcebrandsmrf_001
MHQP 2009/2010 Perinatal Care Recommendations December 29, 2009
Posted by mhumel in : Informational Purposes Only , add a comment
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A Message from the Board of Medicine December 21, 2009
Posted by mhumel in : Notice of Changes , add a commentGreetings from the Massachusetts Board of Registration in Medicine. On behalf of the Massachusetts Department of Public Health, we hope you find the attached information helpful in your practice.
Double your patients’ chances of quitting smoking!
When you refer them to QuitWorks using the attached enrollment form, your patients will receive a FREE two-week supply of nicotine patches—and FREE phone-based counseling!
Smokers who use medications and counseling are more than twice as likely to quit permanently. Those whose doctors also talk with them about quitting are even more successful.
QuitWorks is a free service from the Massachusetts Department of Public Health for all Massachusetts residents, regardless of health insurance status. The nicotine patch offer runs through June 30, 2010, or while supplies last. Some medical restrictions apply.
Start using QuitWorks today by visiting www.QuitWorks.org.
qwenrollmentformnewsletter-v1-1
IMPORTANT REMINDER REGARDING MEDICARE REQUIRED FRAUD, WASTE AND ABUSE TRAINING December 1, 2009
Posted by mhumel in : Policy Reminders , add a commentPlease be advised if you are a practice that does see Medicare patients you must complete this training by 12/31/09. Please read the attached. 2nd-notice-medicare-fwa-provider-communication
2010 Formularies now available. Please see below: December 1, 2009
Posted by mhumel in : Informational Purposes Only , add a commentDear Provider,
The 2010 Health New England (HNE) formularies are is now available on line at hne.com. Formularies available include:
- The HNE Formulary for our three-tiered pharmacy benefit package lists our Tier I (Generic) and Tier II (Preferred Brand) drugs. Medications not listed on the formulary default to Tier III (Non-Preferred Brand).
- The HNE Performance Formulary is our innovative, 2-Tier pharmacy benefit. Tier 1 includes all generic drugs. Tier 2 includes specific brand name drugs carefully selected based on clinical efficacy and cost efficiency. This HNE Performance Formulary rider is sold only with a limited number of plans.
- The HNE Medicare Advantage Formulary – exclusively for members enrolled in our Medicare Advantage plans with pharmacy coverage
- The HNE Be Healthy Formulary – exclusively for members enrolled in our MassHealth plans.
The formulary also lists of medications with
- Quantity limitations
- Step therapy requirements (i.e., a trial of a generic drug in that class),
- Prior-authorization requirements.
We have forms available for your use when prescribing these medications. Completing the form can avoid delays in our review process by ensuring that we have all the information we need to make a decision. You can obtain forms on the HNE website, hne.com, or by contacting HNE Member Services at 1-800-310-2835. You also may request prior authorization by calling our designated Prior Authorization line at 1-888-806-4998.
The HNE online formulary is updated throughout the year as changes are made to the formulary.
Please consider the cost differential between each tier when prescribing. For example, under the HNE Formulary, copayments vary by plan; however, in general, the copayment differential between Tier II and Tier III is at least $15.00/month, The difference between Tier I and III is at least $35.00/month. By using generic drugs or prescribing therapeutic equivalents at a lower tier level, you can significantly reduce costs to your patients. Lower costs often translate to enhanced medication compliance. HNE covers at least one therapeutic agent for each disease state at the Tier I and Tier II levels.
We appreciate your continued partnership in providing access to high-quality, affordable care to our community here in Western Massachusetts. If you have any questions, please call your Provider Relations representative at 413-787-4000.
Sincerely,
Donna L. O’Shea, M.D.
Associate Medical Director