E-HNE! June 16, 2010
Posted by mhumel2 in : HNE/Industry News and Information , add a commentPlease click on the link below to see new information on our E-HNE services!
Introducing HNE Be Healthy! HNE’s new Medicaid Product effective July 1, 2010 June 14, 2010
Posted by mhumel2 in : HNE/Industry News and Information , 5commentsHealth New England, Inc. (HNE) is excited to introduce our new MassHealth (Medicaid) plan option that will be available soon in Western Massachusetts. The HNE Be Healthy MassHealth plan will serve residents in Western Massachusetts beginning July 1, 2010.
In June 2008, the Commonwealth of Massachusetts opened the bidding process for MassHealth Managed Care Organizations (MMCOs) for the first time in 10 years. HNE submitted a bid and was awarded a contract to serve the Western Massachusetts region.
If you have any questions regarding participation in this new network or any of HNE’s other networks, please visit us online at www.hne.com or contact our Provider Relations Department at (413) 233 3313.
Coming soon we will put a link to the new Medicaid Provider Manual Addendum.
Pharmacy Update June 4, 2010
Posted by mhumel2 in : Pharmacy Updates , add a commentStarting July 1, 2010, HNE has set the following quantity limits for Cymbalta and Effexor XR
Prescription Drug Name |
Maximum Quantity |
| Cymbalta® 20 mg | 30 tablets per 30 days |
| Cymbalta® 30 mg | 30 tablets per 30 days |
| Cymbalta® 60 mg | 30 tablets per 30 days |
Drug Name |
Maximum Quantity |
| Effexor XR ® 37.5 mg | 30 capsules per 30 days |
| Effexor XR® 75 mg | 30 capsules per 30 days |
| Effexor XR® 150 mg | 30 capsules per 30 days |
Reason for change; To help control the continued rising cost of prescription drugs and ensure safe and effective use, HNE may limit the quantity covered for certain drugs.
HCAS Website Update June 4, 2010
Posted by mhumel2 in : HNE/Industry News and Information , add a commenthttp://www.hcasma.org/ToolsAndResources.htm
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)
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…)