HNE Criteria for Benefit Decisions are available via HNE.com or by calling Member Services at 787-4004 or 800-310-2835. To view HNE-developed clinical criteria click here:
Please note that HNE recently reviewed its Clinical Care Guidelines for Depression. There were no changes made during this review.
These guidelines are available on hne.com. Please click on the link to view the guidelines:
As of January 1, 2013, HNE now offers both Medicare Advantage and Medicare Supplement plans.
Today, HNE offers Medicare Advantage plans in Hampden, Hampshire, Franklin and Berkshire Counties. HNE has approximately 8,000 Medicare Advantage members. HNE is the only 5-Star Rated health plan in Massachusetts, two years running! With a 5-Star rating, Medicare beneficiaries who are not currently on an HNE Medicare Advantage plan can enroll in an HNE Medicare Advantage plan anytime during the 2013 calendar year.
As of 1/1/2013, HNE now offers Medicare Supplement plans. HNE has two Medicare Supplement plans, the HNE Medicare Supplement Core and the HNE Medicare Supplement 1. These plans can be bought by any Medicare-eligible resident of Massachusetts. As a company, we don’t anticipate a large number of Medicare Supplement members in the 2013 calendar year, however if you encounter an HNE Medicare member, here are some important tips:
HNE Medicare Advantage Plans
- ID numbers start with the number 9.
- Cards have the HNE Medicare Advantage logo on them.
- Members should only show you their HNE Medicare Advantage card
- You should only bill HNE (not Medicare) for their services.
- You must be participating in the HNE Medicare Advantage network to treat these members.
HNE Medicare Supplement
- Plan ID numbers start with the number 6.
- Cards look similar to our commercial membership cards.
- Members should show both their HNE Medicare Supplement card and their Medicare Red, White and Blue card.
- Medicare will be the primary payer. You should bill Medicare first.
- You don’t have to be in the Medicare Advantage network to treat these members.
For both our HNE Medicare Advantage and HNE Medicare Supplement member inquiries, you can call HNE’s Medicare dedicated Member Services team at 413.787.0010 or 877.443.3314.
Attached is a copy of of the recent mailing regarding the new Behavioral Health CPT codes for 2013.
In late 2012, CMS announced the ICD-10 Final Rule which mandates the use of two code sets, ICD-10-CM for diagnostic conditions and ICD-10-PCS for inpatient procedure codes, by October 1, 2014. The ICD-10-CM will replace ICD-9-CM volumes 1 and 2 for diagnosis codes. The ICD-10-PCS will replace ICD-9 volume 3 for inpatient procedure codes.
In preparation for HNE’s ICD-10 Implementation, we have prepared this ICD-10 Resource Site where you will find important information about HNE’s role in meeting the ICD-10 Final Rule. Please watch for upcoming HNETalk announcements for more details and check-in to HNE.com as we review compliance progress, answer FAQs and provide important information as we continue to refine our processes and systems.
ICD-10 Final Rule Link: http://www.gpo.gov/fdsys/pkg/FR-2012-09-05/pdf/2012-21238.pdf
ICD-10 Resource Site Link: http://hne.com/HNE_Providers/ICD10/index.html
The Mass Collaborative is a group of payers, providers, and trade associations within the health care community focused on reducing administrative complexities in the health care system. In order to better understand the health care community’s awareness of the Collaborative, we are issuing a survey and would appreciate your response. The survey will be distributed by the Massachusetts Hospital Association, the Massachusetts Medical Society and several health plans. It is designed to help us assess the impact and success of current statewide collaborative efforts, and will also be used to help us identify new initiatives to aide you in your daily operations.
Since 2009, the Mass Collaborative has been seeking to identify ways to improve administrative efficiency within the healthcare system inMassachusetts. The Collaborative consists of numerous provider and payer organizations as well as the Massachusetts Health Data Consortium (MHDC), Massachusetts Association of Health Plans (MAHP), Massachusetts Medical Society (MMS) and the Massachusetts Hospital Association (MHA).
Please complete this brief survey by February 15, located at:
As posted on January 3rd, MassHealth Managed Care Organizations (MCO) are required to collect National Drug Code (NDC) information on claims for drugs administered as part of an outpatient visit as required by the Affordable Care Act.
Entities participating in the 340B program are exempted from this requirement and do not need to submit NDC codes for drug claims.
However, all 340B covered entities must add the modifier “UD” with the HCPCS code to indicate that the drug was purchased through the 340B program. Submitting the “UD” modifier will enable HNE to ensure that your claims are not denied for failure to submit the NDC code. The “UD” modifier will serve as a flag to allow your claims through the system.
If you have any questions, please contact HNE’s Provider Relations staff at 413.233.3313 or 800.842.4464, extension 5000.
We appreciate your assistance in helping us meet the requirements of the Affordable Care Act.
***Please note that this is for inplan, participating providers only***
HNE is happy to to announce that EFT is now available! Please click on the link below for a copy of the enrollment form. The average turnaround time is 2 weeks from the date you submit the form, however, please allow some additional time as this new process is rolled out. If you have any questions, please contact Provider Relations at 800.842.4464, extension 5000.
For six consecutive years, the National Committee for Quality Assurance (NCQA) has ranked HNE in the top 15 health plans nationwide. We look forward to maintaining this position with the help of the clinicians.
The NCQA’s standardized measurement criteria—known as the Healthcare Effectiveness Data and Information Set (HEDIS)—includes clinical components, which are measured using data from claims and medical record reviews. In 2013, HNE will be reviewing medical records for the following HEDIS measures:
- Adolescent immunization status (including Human Papillomavirus Vaccine (HPV) for female adolescents)
- Adult Body Mass Index (BMI) assessment
- Childhood immunization status
- Cholesterol management for patients with cardiovascular conditions
- Colorectal cancer screening
- Comprehensive diabetes care
- Control of high blood pressure
- Immunizations for adolescents
- Prenatal and postpartum care
- Weight assessment and counseling on nutrition and physical activity for children and adolescents
In the next few weeks, you may receive a letter requesting copies of medical records. We appreciate your assistance in providing the medical information as requested. All information is needed by March 15, 2013 in order to meet regulatory requirements.
Your prompt response will ensure that HNE’s HEDIS measures accurately represent the high quality of care that you provide to our members. If you have questions about the HEDIS 2013 requirements or our medical record review process, please contact Pat Scheer, Director of Quality Operations at 413-233-3435.