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May 232011
 

Eligible Children Aged 1–5 Years: an Updated Approach to Targeting a Group at High Risk

Anne M. Wengrovitz, MPH, Mary Jean Brown, ScD
Advisory Committee on Childhood Lead Poisoning, Division of Environmental and Emergency Health Services, National Center for Environmental Health

Corresponding preparer: Mary Jean Brown, ScD, Division of Environmental and Emergency Health Services, National Center for Environmental Health, CDC, 4770 Buford Highway, MS F-40, Atlanta, GA 30341. Telephone: 770-488-7492; Fax: 770-488-3635; E-mail: mjb5@cdc.gov.

Summary
Lead is a potent, pervasive neurotoxicant, and elevated blood lead levels (EBLLs) can result in decreased IQ, academic failure, and behavioral problems in children. Eliminating EBLLs among children is one of the 2010 U.S. national health objectives. Data from the National Health and Nutrition Examination Survey (NHANES) indicate substantial decreases both in the percentage of persons in the United States with EBLLs and in mean BLLs among all age and ethnic groups, including children aged 1–5 years. Historically, children in low-income families served by public assistance programs have been considered to be at greater risk for EBLLs than other children. However, evidence indicates that children in low-income families are experiencing decreases in BLLs, suggesting that the EBLL disparity between Medicaid-eligible children and non–Medicaid-eligible children is diminishing. In response to these findings, the CDC Advisory Committee on Childhood Lead Poisoning Prevention is updating recommendations for blood lead screening among children eligible for Medicaid by providing recommendations for improving BLL screening and information for health-care providers, state officials, and others interested in lead-related services for Medicaid-eligible children.

HNE has provided to you below, some key information links, including the link to the CDC document of which is cited above.

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5809a1.htm

High Risk Communities for Childhood Lead Poisoning 

Childhood Lead Poisoning Prevention Program

2010/11 Recommendations Adult Preventive Care

 Posted by at 4:42 pm
Feb 142011
 

At HNE, our mission is to improve the health and life of the people in our communities. Our green
initiatives, including replacing print media with electronic, supports this mission. We have discontinued
our practice of enclosing an Explanation of Payment (EOP) with your payment. Instead, we’ve set up an
easy to use, secure web portal where you can review your EOP anytime, anywhere you have internet
access. Just go to http://hnedirect.com, if you have a HNEdirect account, login to HNEDirect and find
your EOPs under the Reports tab. If you do not have an HNEDirect account, click “EOP Search” then
complete all of the information under the heading EOP Search. Make sure you review and agree to the
User Agreement.

To protect patient privacy, you will have to start a new search for each EOP.

 Posted by at 4:03 pm
Oct 272010
 

Dear HNE Provider:

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.

We have attached a copy of an amendment to the HNE Explanation of Coverage. We will send this amendment to HNE subscribers with the next edition of our member newsletter, My Health Matters. If you have any questions, please call me at 413-233-3382.

Best regards,
Joanne Walton-Bicknell
Provider Relations Manager

Semi-Annual Notice of Changes

 Posted by at 9:03 am
Jun 242010
 

Massachusetts patients assess their experiences with primary care in first comprehensive survey since state health reform implementation

Boston, MA-June 24,2010 - A report released today by Massachusetts Health Quality Partners (MHQP) provides the first comprehensive assessment of how patients rate their experiences with primary care since the state’s groundbreaking health reform law was implemented.

Read More>>

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 Posted by at 9:53 am
May 262010
 

Helpful Hints When Submitting Pharmacy Authorization Requests

We appreciate your partnership in providing excellent care and service to our members. As your business partner, we are always looking for ways to enhance your experience with us. One improvement we’d like to make is to reduce invalid pharmacy authorization requests. They can cause you and your staff unnecessary re-work and result in delays for your patients. Here are some helpful hints to follow when submitting a pharmacy authorization request form:

Check the Formulary on HNE.com: Most requests that we receive are unnecessary. They may be for drugs that do not require prior authorization, or the member might already meet the benefit requirement (e.g., he or she already completed the Step Therapy requirement). The on-line Formulary provides coverage information about all the drugs we cover, including:

  • Prior authorization requirements
  • The generic equivalents for brand name drugs
  • Quantity limitations
  • Step therapy parameters, including a listing of first line drugs

Whether or not the authorization reviewer is HNE or our HNE Pharmacy Benefit Manager PBM make sure the member has their pharmacy benefit through HNE. Some of our employer groups do not have their pharmacy benefit through HNE. Their benefits are ‘carved out’. The employer groups below have a carve-out pharmacy benefit. For your convenience, we have provided contact information for the groups Pharmacy vendor.

Group Pharmacy Vendor Contact Number
Sisters of Providence
Health System
Caremark 800-966-5772
The Diocese of Springfield CVS Caremark 800-565-7091
Mass Mutual Cigna 800-835-3784
Baystate Health Systems Med Metrics 866-865-0147

Please remember that the turnaround time for prior authorizations is 24-48 hours. We do our best to turn these requests around as quickly as possible. If you are waiting for a response to a prior authorization request, please do not submit a duplicate request. This can cause rework and result in a delay in processing the request

We appreciate your patience!


[dbrown11]Are all these phone numbers correct, verified?

 Posted by at 12:16 pm
May 072010
 

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.

The following link will open a copy of the amendment to the HNE Explanation of Coverage for fully funded plans:

<< READ NOTICE >>

We will send this amendment to HNE subscribers with the next edition of our member newsletter, My Health Matters.

 Posted by at 2:37 pm
Mar 182010
 

Thank you for participating in our Medicare Advantage Network. I want to provide you with a description of our Clinician Home Visit Program for our Medicare Advantage members. With the Health New England (HNE) Medicare Advantage Plan, your patients have many benefits and services in addition to the traditional Medicare program. Continue reading »

 Posted by at 11:13 am