Dec 122014
 

Code of Conduct

It is Health New England’s (“HNE”) policy to conduct its business in compliance with all applicable federal and state laws and regulations and to assure that HNE operates in a manner consistent with the letter and the spirit of the laws. HNE expects its employees, management, governing body members and first tier, downstream and related entities (FDR’s) (“Covered Individuals”, refer to the HNE Code of Conduct, Section E, for definitions), to adhere to this Code of Conduct when conducting business on behalf of HNE and its subsidiaries.

 

The full statement of our Code of Conduct is posted to the hne.com Compliance page: http://www.healthnewengland.com/quality/compliance.html

Reporting Concerns

All Covered Individuals are required to promptly report potential compliance or Fraud, Waste, or Abuse issues of which they have knowledge or a good faith belief.

  1. Call the HNE Compliance Hotline at (800) 453-3959 (available 24/7, toll-free; reports can be made anonymously)
  2. Potential fraud may also be reported directly to the Department of Health and Human Services (HHS) Office of Inspector General (OIG) Hotline.

Contacting the HHS OIG Hotline

Phone:       1-800-HHS-TIPS (1-800-447-8477)

Fax:           1-800-223-8164

E-Mail:      HHSTips@oig.hhs.gov

Web Site: https://forms.oig.hhs.gov/hotlineoperations/

TTY:          1-800-377-4950

Mail:          Office of Inspector General

                     Department of Health and Human Services

                     Attn: HOTLINE

                     PO Box 23489

                     Washington, DC 20026

 

Annual Training Requirement

FDRs who have not met the FWA certification requirements through enrollment into the Medicare program or accreditation as a DMEPOS must certify that they have taken the CMS-developed or comparable training. Go to the Medicare Learning Network (MLN) Provider Compliance page for the CMS-developed training: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/ProviderCompliance.html

 

If you have any questions or concerns, please feel free to contact Judy  Collins, HNE’s Compliance Specialist at 413.233.3357 or via email at jcollins@hne.com

 

 

 

Dec 012014
 

This message is to remind you that HNE will honor any approved, existing Prior Authorizations for care for members reassigned to HNE Be Healthy, as long as the authorization is for a covered benefit. This notification applies to the medical necessity approvals. Any previously negotiated contractual agreements will not apply. HNE will reimburse at Massachusetts Medicaid rates for all out-of-network services.

The process for honoring pre-existing Prior Authorizations for care is as follows:

 Please fax the Standard Prior Authorization Form, along with a copy of the approval letter issued by the prior Managed Care Organization (MCO), to 413.233.2700. Health Services representatives are available to assist you Monday through Friday, between the hours of 8:00 a.m. and 5:00 p.m., at 413.787.4000 x 5027.

Dec 012014
 

This message is to remind you that HNE will honor any approved, existing Prior Authorizations for care for members reassigned to HNE Be Healthy, as long as the authorization is for a covered benefit. This notification applies to the medical necessity approvals. Any previously negotiated contractual agreements will not apply. HNE will reimburse at Massachusetts Medicaid rates for all out-of-network services.

The process for honoring pre-existing Prior Authorizations for care is as follows:

Please fax the Standard Prior Authorization Form, along with a copy of the approval letter issued by the prior Managed Care Organization (MCO), to 413.233.2700. Health Services representatives are available to assist you Monday through Friday, between the hours of 8:00 a.m. and 5:00 p.m., at 413.787.4000 x 5027.

Dec 012014
 

With the impact of new Medicaid members joining HNE Be Healthy, we understand that you may have questions about how to become credentialed with MBHP, our vendor for the behavioral health benefits for these members. The process is outlined below.

In order to become credentialed with MBHP, behavioral health providers are being asked to send a letter of intent to the following e-mail address: MBHPNetworkManagement@valueoptions.com. In your letter of intent, please highlight that you have clients whom you are currently seeing who have recently switched to HNE Be Healthy, and in an effort to avoid a disruption in services, you are requesting to join their network ASAP. It may be helpful to expedite the process by attaching your most current CV or resume’ along with your letter of intent.

If you have any further questions or concerns please feel free to call the network operations department at MBHP at 800-495-0086

Robert Azeez, M.Ed., CADC II, CRC, LADC-I

Medicaid Behavioral Health Manager

Health New England

razeez@hne.com

413-233-3438

Nov 262014
 

 

HNE Be Healthy Behavioral Health Providers please be aware of a new “BH transitional visit”, being introduced by MBHP for our members that is now effective. The transition visit aims to improve Health New England (HNE) Be Healthy Members’ connectedness to their aftercare services upon discharge from adult inpatient facilities by promoting adherence to discharge, medication, and risk management plan(s).  The purpose of the transition visit is to reduce readmission to inpatient facilities and increase community tenure by providing aftercare supports and resources upon discharge. Attached are transitional visit forms to utilize for this service.

 

 MBHP-HNE Be Healthy Transition Visit Form 11-25-14

Nov 262014
 

There was a recent  mailing that was sent to providers who currently have patients that are utilizing prescription NEXIUM®, Kapidex™, Dexilant, Prevacid® Solutab™, omeprazole sodium bicarbonate (generic Zegerid®), or rabeprazole. Effective January 1, 2015, HNE will no longer cover prescription NEXIUM®. HNE will instead cover the over-the-counter (OTC) version: Nexium® 24HR.

Below is an example of which Nexium selection you should choose when you electronically prescribe (E-prescribe) or write your Nexium 24HR prescription:

Nexium 24HR                                                 20mgCPDR                                                                   Oral

Nexium® 24HR is available in 14, 28, and 42 count packages. The new prescription will need to be written for one of these listed quantities, as Nexium® 24HR is not available in the standard 30 count package.

For ease of transition we are asking HNE providers to proactively apply the following changes when prescribing Nexium® 24HR:

  • Change prescriptions for 30 NEXIUM® 20 mg to 28 Nexium® 24HR capsules per month.
  • Change prescriptions for 30 NEXIUM® 40 mg to 56 Nexium® 24HR capsules per month.

Members and pharmacies have already been made aware of this change.

The reject messaging on the claim at point of service will reflect the bullets above. Pharmacies will be asked to contact the prescribing physician for verbal authorization to switch.

Additionally, since the cost of OTC Nexium ®24HR product is considerably lower than other brand name and some generic proton pump inhibitors (PPIs), HNE will now require Nexium ® 24HR (OTC) as a step therapy requirement for the following PPIs effective January 2015:

  • Kapidex
  • Dexilant
  • Prevacid® Solutab
  • Omeprazole sodium bicarbonate (generic Zegerid®)
  • Rabeprazole

For HNE to cover the Step Therapy drugs listed above, the member must try all of the corresponding First Line drugs, which include omeprazole, pantoprazole, and Nexium ®24HR (OTC).

Should you have any questions, please feel free to contact our Provider Relations at 413.233.3313 or 800.842.4464, extension 5000.

Nov 202014
 

 

Results from the survey to PCPs on communication with BH providers who are treating your patients

HNE is committed to supplying our providers with the information they need to deliver high quality care to our members. As part of that commitment, we asked you to participate in a survey to assess your experience with communications from behavioral health providers who are treating your patients. The results from the survey are as follows:

 

                                             Do you receive reports?       Are they timely?             Are they helpful?

Almost always (>80%) 10% 18% 18%
Most of the time (60-80%) 0% 4% 35%
Half of the time (50%) 12% 12% 0%
Some of the time (20-40%) 18% 18% 17%
Few times (<20%) 30% 18% 6%
Never 30% 30% 24%

 

This information will help us develop methods to improve the continuity and coordination of treatment of our members. Thank you for taking the time to fill out the survey and returning it to HNE.

 

 

 

 

Oct 212014
 

Helpful ADHD Materials:

Below is a link to additional information and the ADHD toolkit created conjointly by the National Initiative for Children’s Healthcare Quality and the American Academy of Pediatrics. Through this link you can access the ADHD Toolkit. Simply click on the link below then go to the final version of the ADHD Toolkit. The toolkit is introduced as a Practitioner’s Toolkit but we have found that it has resources and information that are very user-friendly for parents. http://www.nichq.org/childrens-health/adhd/resources/adhd-toolkit

Oct 012014
 

A reminder that HNE is proud to announce that we will be co-sponsoring and subsidizing a Continuing Medical Education (CME) event on behavioral health integration in the primary care setting. CMEs will be provided in the area of risk management. Please see the attached brochure for information and how to register for this event. The cost of the event, if you register before October 6th is $25.00. The cost of the event after October 6 is $35.00.

 Practical Strategies flyer 2014