Important Notice to Participating HNE Providers Regarding Paper Explanation of Payment July 29, 2010
Posted by mhumel2 in : Notice of Policy Changes , add a commentWe initially notified you on July 1st that the paper EOPs would be turned off effective August 2nd. This date has changed to September 7th. You will continue to receive paper EOPs until then. Our IT Department is currently revamping the HNEDirect site to make it easier for you to access the electronic EOP once the paper is turned off.
Please contact Provider Relations at 413-233-3313 if you have any questions or concerns.
Important Notice to Participating HNE Providers Regarding Paper Explanation of Payment July 1, 2010
Posted by mhumel2 in : Notice of Policy Changes , 7commentsPlease note: Your Explanation of Payment (EOP) now is available on HNEDirect.com. Starting August 2, 2010, we no longer will send the paper version of the EOP with your check.
Signing up for HNEDirect is easy:
1. Go to hne.com
2. Click “HNEDirect” in the lower, right hand corner
3. Click “Login Screen” at the end of the introduction
4. Click “Need to Register?”
5. Follow the simple, step-by-step instructions to sign up
After you register, we’ll confirm your account and send you a confirmation email.
In addition to viewing your EOP on-line, you also will have the option to print it if you need a paper copy.
If you have any questions, please contact Provider Relations at 413-233-3313 or toll-free at 800-842-4464, extension 5000, Monday through Friday. A representative is available to speak with you between the hours of 8:00 a.m. and 4:30 p.m. Eastern Standard Time.
Thank you.
Revision to HNE’s Obstetrical Billing Policy June 1, 2010
Posted by admin in : Notice of Policy Changes , add a commentRevision to HNE’s Obstetrical Billing Policy
Helpful Hints Regarding Pharmacy Prior Authorizations May 26, 2010
Posted by admin in : Notice of Policy Changes , add a commentHelpful 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?
July 2010 Notice of Changes to Fully Funded Plans May 7, 2010
Posted by admin in : Notice of Policy Changes , add a commentAs 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:
We will send this amendment to HNE subscribers with the next edition of our member newsletter, My Health Matters.
Revision to HNE’s Obstetrical Billing Policy April 29, 2010
Posted by admin in : Notice of Policy Changes , 2commentsHNE’s Obstetrical Billing Policy (2)
Changes to GIC Member Benefits effective 2/1/10 January 19, 2010
Posted by admin in : Notice of Policy 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-mailing1
IMPORTANT CHANGE TO HNE ID CARDS January 7, 2010
Posted by admin in : Notice of Policy 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.
$0 Preventive Copay Notice May 4, 2009
Posted by admin in : Notice of Policy Changes , add a commentPlease click on the below link to find the April 2008 notice regarding $0 copay for preventive visits.