HNE’s 2010-2011 Flu Policy August 17, 2010
Posted by mhumel2 in : Policy/Administative Reminders , add a commentInfluenza Virus/Flu Vaccine: HNE covers the flu vaccine for any member over six (6) months of age. The flu vaccine may be obtained through the PCP. If the PCP does not have flu vaccine, it may be obtained elsewhere, however, the member would have to pay for it and then submit for reimbursement. They will need to submit their itemized receipt to HNE attn: Member Services. We will then log their request and submit to Claims for processing. If the member pays for the flu shot out of pocket at a clinic, work etc….we will reimburse 100% of the charge. If the member gets this at their PCP office or an in-plan provider office and we are billed for the administration of the shot along with the actual immunization, an OV copay would apply. For GIC members, the flu shot is on the preventative code list for children up to the age of 18, which means no copay would apply.
HNE does NOT cover the Live Attenuated Influenza Vaccine/FluMist® as this is intranasally administered to “healthy” people 5-49 years of age who wish to avoid influenza. However, HNE has allowed coverage effective August 1, 2009 for FluMist (CPT 90660) for members aged 2-18.
NEW PRIOR AUTHORIZATION REQUEST FORM!!!! (PARF) March 30, 2010
Posted by admin in : HNE/Industry News and Information, Policy/Administative Reminders , add a commentPlease familiarize yourself with the new form and discard any previous copies.
PRIOR AUTHORIZATION REQUEST FORM
Medicare Advantage Nurse Practitioner Home Visits March 18, 2010
Posted by admin in : Policy/Administative Reminders , add a commentThank 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. (more…)
New Copayment Information on HNEDirect! March 12, 2010
Posted by admin in : Policy/Administative Reminders , add a commentThere is now additional copayment information on HNEDirect. You can now view the annual eye exam, annual gyn exam and physical/occupational therapy copayments. Keep the suggestions coming!
New Provider Appeal Forms March 11, 2010
Posted by admin in : Policy/Administative Reminders , add a commentPlease replace any old versions of the Provider Appeal form with the new version. There are also 2 newly created forms for On-Time Corrected claims (corrected claims submitted within 180 days of the date of service) and a Coordination of Benefits (COB) form for claims issues involving other insurance (worker’s compensation, motor vehicle, etc.)
provider-appeal-form ottcform2010 cobform2010
Interested in receiving email notifications when we update the site? February 23, 2010
Posted by admin in : Policy/Administative Reminders , add a commentClick here – http://www.hnetalk.com/Provider/wp-login.php?action=register
Or call 413-233-3313
Ensuring Continuity and Coordination of Care February 12, 2010
Posted by admin in : Policy/Administative Reminders , add a commentConfidentiality of patient information has always been foremost in the minds of HNE. The advent of HIPAA has actually simplified the process for those providers caring for a specific patient by permitting the sharing of pertinent information without the need for the patient’s signature. The PCP’s role is to not only provide first-line care, but also to oversee and coordinate the care that his or her patients receive from other providers. Communicating patient care information from other care providers back to the member’s PCP is very important to help ensure safe care. Failure to share information about a patient’s care can result in suboptimal outcomes, increased costs, and medical errors. This process can become especially difficult for the majority of HNE members since they are permitted to self–refer to most specialists, including behavioral health specialists. Whenever patients are admitted to hospitals or skilled nursing facilities or when they are referred to home health agencies for care, managing their care can become even more fragmented for PCPs. Receiving reports of therapies and medications provided and concerns identified by other care providers is essential to ensure that the patient’s care is safe, proper, and unduplicated. This does not always occur, even when the referral process is utilized.
HNE monitors continuity and coordination of care annually through medical record review of PCPs, high-volume specialists and OB/GYNs, skilled nursing facilities, and home health agencies; the provider satisfaction survey; and through focus studies. During medical record review, HNE assesses continuity and coordination of care by reviewing three key pieces of information in medical records: 1. Presence of reports of consultation 2. Evidence of physician review by initialing of lab/x-ray reports 3. Notation of a time frame for the next office visit.
To improve the communication process, we need help from all providers.
We ask all PCPs to:
· File all progress notes, visit and discharge summaries, and other care documentation received from other care providers, including skilled nursing facilities or home health agencies.
· Ask your patients if they are receiving any other medical services.
· Document any verbal communications with other care providers in the patient’s chart.
Specialists should:
· Verify with the member the member’s PCP
· Send a report of consultation or speak with the PCP.
o Locate PCP addresses in the PCP Provider Directory on HNE’s website
Good communication will help to ensure safe and proper patient care.
IMPORTANT REMINDER TO GIC TIERED PHYSICIANS! January 19, 2010
Posted by admin in : Policy/Administative Reminders , 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 REMINDER REGARDING MEDICARE REQUIRED FRAUD, WASTE AND ABUSE TRAINING December 1, 2009
Posted by admin in : Policy/Administative 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