Jan 062014
 

Submitting Claims to HNE

HNE will follow the Centers for Medicare & Medicaid Services (CMS) guidelines regarding ICD-10 cutover and will not accept claims with ICD-9 codes for dates of service after the defined cutover date (i.e., 10/1/2014). They will be returned to the provider for correction and resubmission.

 HNE participating in the Collaborative Testing Program (CTP)

To proactively address the challenges involved in transitioning to ICD-10, the Massachusetts Health Data Consortium (MHDC) has launched the nation’s largest state-wide ICD-10 initiative called the Collaborative Testing Program (CTP). The CTP’s aim is to reduce the risk of the ICD-10 transition and save time and resources for payers, providers, vendors and intermediaries by offering  a fully hosted, product and services testing solution for file validation, coding content and business impact. Currently over 70 organizations, including Health New England, are involved with efforts focused on: collaborative testing design and implementation planning; common mapping and computer-assisted coding technologies; training, education, and clinical documentation best practices; and standardized communication.

For the most up-to-date, specific information on the CTP program, please visit the MHDC ICD-10 CTP website, http://www.mahealthdata.org/ctp

Reminder

HNE has created a web page on HNE.com for ICD.  You may access the page at http://hne.com/HNE_Providers/ICD10.  On this page you will find information related to HNE’s implementation timeline.  There are also links to other organizations which may provide useful information.

Dec 202013
 

As part of our efforts to comply with the federally mandated CAQH Committee on Operating Rules for Information Exchange (CORE) in effect on January 1, 2014, HNE will be enhancing our processes for both EFT and ERA. Please click on the link below to click on a notification being sent to providers regarding this enhancement:

CORE letter

Dec 162013
 

To make sure that health plans and their members have the most up-to-date information about your practice, the Mass Collaborative*  is pleased to introduce the Standardized Provider Information Change Form.   When you are changing your practice name, address, phone numbers, e-mail, billing company, or other practice information, you only need to complete this single form and send it via e-mail, fax, or US mail to each health plan you contract with instead of completing a different form for each health plan. The following health plans now accept this form:

 

  • Blue Cross Blue Shield of Massachusetts
  • BostonMedicalCenter Healthnet Plan
  • Celticare Health Plan of Massachusetts
  • Fallon Community Health Plan
  • Fallon Total Care
  • Harvard Pilgrim Health Care
  • Health New England
  • Neighborhood Health Plan
  • Network Health
  • Tufts Health Plan
  • Senior Whole Health
  • Unicare

 

This form should not be used to submit credentialing or contractual changes. Continue to use individual health plan forms for those changes.  In some circumstances, individual health plans may need to follow up with providers for additional information regarding a demographic change. Please click the link below to access the form on www.hne.com 

http://hne.com/HNE_Providers/documents/PROVIDER-INFORMATION-CHANGE-FORM.pdf

Questions?

For questions about specific health plan policies or requirements, contact Provider Relations at 413.233.3313 or toll-free at 800.842.4464, extension 5000.

* The Mass Health Collaborative is a multistakeholder group committed to reducing health care administrative burdens and costs. Members of the Mass Collaborative include the Massachusetts Hospital Association, Massachusetts Medical Society, Blue Cross Blue Shield of Massachusetts, the Massachusetts Association of Health Plans, the Massachusetts Health Data Consortium, MassHealth, Healthcare Administrative Solutions, as well as many local payers and providers.

Dec 062013
 

For several years, the National Committee for Quality Assurance (NCQA) has ranked HNE among the top 30 health plans nationwide.

The NCQA’s standardized measurement criteria—known as the Healthcare Effectiveness Data and Information Set (HEDIS)—includes clinical components, which are measured using data from claims and medical record reviews. In 2014, HNE will be reviewing medical records for the following HEDIS measures:

  • Adult Body Mass Index (BMI) assessment
  • Childhood immunization status
  • Cholesterol management for patients with cardiovascular conditions
  • Colorectal cancer screening
  • Comprehensive diabetes care
  • Control of high blood pressure
  • Human Papillomavirus Vaccine (HPV) for female adolescents
  • Immunizations for adolescents
  • Prenatal and postpartum care
  • Frequency of ongoing prenatal care (Medicaid only)
  • Weight assessment and counseling on nutrition and physical activity for children and adolescents
  • Lead Screening in children (Medicaid only)
  • Well-child visits in the first 15 months of lLife (Medicaid only)

In the next few weeks, you may receive a letter requesting copies of medical records. We appreciate your assistance in providing the medical information as requested.
Your prompt response will ensure that HNE’s HEDIS measures accurately represent the high quality of care that you provide to our members. If you have questions about the HEDIS 2014 requirements or our medical record review process, please call Pat Scheer, Director of Quality Operations at 423-233-3435.

Oct 092013
 

This is specifically for mail order medications for maintenace medications.

 

Dear Prescriber:

 Health New England (HNE) and Catamaran Home Delivery would like to take this opportunity to provide you with updated contact information for you when using Catamaran Home Delivery services.  We hope this reminder will make it easy to contact our team who are specially trained on the HNE mail order program and will be able to assist you with all of your pharmacy Home Delivery needs.

 Prescriber Contact Information to Submit a Prescription

  •  Fax a prescription to Catamaran Home Delivery at 1-855-330-3865
  •  Submit a prescription electronically (e-prescribing) by making this selection from in your web portal application.

                                   Catamaran HD (Avon Lake, OH)

 Contact Catamaran Home Delivery by phone at 1-800-233-3872, option 7 to speak to a pharmacist and call in a prescription.  Please provide HNE Member ID number, the patient’s name and the patient’s Date of Birth.

 

Oct 082013
 

Are you ready for ICD-10? 

 To assist providers meet the ICD-10 compliance deadline of October 1, 2014,Massachusettshealth plans and MassHealth are conducting the third annual ICD-10 provider progress survey. The survey will assess statewide compliance efforts underway and will be used to develop education strategies, training materials, and identify resources to aide providers in their ICD-10 preparations.

 To avoid duplicate survey requests from various health plans, HealthCare Administrative Solutions (HCAS) developed this survey on behalf of the following organizations:

 Blue Cross Blue Shield ofMassachusetts

  • BostonMedicalCenterHealthNet Plan
  • Fallon Community Health Plan
  • Harvard Pilgrim Health Care
  • HealthNew England
  • MassHealth
  • Neighborhood Health Plan
  • Network Health
  • Tufts Health Plan

 In addition, the Massachusetts Health Data Consortium (MHDC), Massachusetts Association of Health Plans (MAHP), Massachusetts Medical Society (MMS) and the Massachusetts Hospital Association (MHA) support this effort.

 Please complete this brief survey, located at: https://www.surveymonkey.com/s/HCASICD10Survey

by October 31, 2013.

 An ICD-10 summary of statewide results report will be available on the HCAS website in November at http://www.hcasma.org/NewsAndInformation.htm.

 To avoid duplicate responses, we request that each organization required to comply with the ICD-10 mandate provide a single unified survey response on behalf of that organization.