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 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:


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