NHP Provider Announcements Archive
Update: The New NHPNet Design
Effective November 13, 2012
The new NHPNet design is now available! The new design offers improved performance of some of NHPNet's current features in addition to new functionality (Key Indicators, Dashboards) plus a new look and feel consistent with our corporate image. Your existing login credentials will allow you to login to the newly designed site.
We’ve developed the following resources to help you get acclimated to the new design:
Update: Prior Authorization
Effective December 1, 2012
- Prior Authorization will no longer be required for PT/ST/OT and most Surgical Day Care (SDC) services
- Changes to NHP's Urine Drug Testing (UDT) policy go into effect
- For full details, please read the provider notice.
Update: NHP Provider Manual
Effective October 1, 2012
NHP's Provider Manual has been updated as of October 1, 2012. You can access it here.
Update: Online Authorization & Referrals
Effective September 10, 2012 - Online Authorizations & ReferralsFor full details, please read the provider notice.
As previously communicated, for services rendered on or after September 10, 2012, Neighborhood Health Plan (NHP) will be instituting an online specialist referral requirement. Referrals will need to be submitted directly through NHP’s on-line authorization tool, NHPNet. To ensure accurate submissions of referrals, please follow the steps outlined in the corresponding NHPNet Online User Guide. Members seeking care from providers other than their assigned PCP will require a referral, except for the services listed below.
Services that Do Not Require a Referral
- Chiropractic, Physical Therapy, Occupational Therapy, Speech Therapy
- Care provided by a specialist while inpatient
- Family planning services
- Vision Care: fitting and dispensing lenses only (Eye exams,
ophthalmology and optometry specialist visits require a referral)
- Care delivered in an OB/GYN Office Visit (routine, preventative and urgent care)
- Outpatient and diversionary Behavioral Health Services
- Special Kids Special Care (SKSC) Pediatric Program
- Urgent and Emergent Services
Effective September 10, 2012, most authorizations need to be submitted directly through NHP’s on-line authorization tool, NHPNet. NHP will no longer accept fax requests for those services designated for transmission through NHPNet. Clinical documentation to support medical necessity may be uploaded along with the request as detailed in the User Guide. At this time NHP will continue to accept clinical documentation by fax. To ensure accurate submissions of authorizations, please follow the steps outlined in the corresponding NHPNet Online User Guide.
You must be a registered user of NHPNet to submit online authorizations and referrals. Please ensure staff who request authorizations and referrals have access to NHPNet. For those that want to register a site or a new site user, go to https://nhpnet.nhp.org/ and register. For assistance please reference the NHPNet user registration guide.
NHPNet Online Auth User Guides
Written step-by-step instructions to get you started
Services Requiring Electronic Submission
NHP has created a guide showing you which services will require electronic submission.
New/Revised Payment Guidelines & Maintenance 90 Program Medications
August 15, 2012
- Learn about recent Payment Guideline updates and an important update regarding NHP's Maintenance 90 Program Medications.
August 6, 2012
We are pleased to announce that we will be using Medfusion/Ascend as our specialty vendor for Synagis. NHP will be covering the cost of the injection as well as the administration of Synagis throughout the respiratory syncytial virus (RSV) infection season (November through March) only if obtained from Medfusion/Ascend Specialty Pharmacy. Synagis and all supplies necessary for the administration will be shipped out and delivered to your office within 24 to 48 hours after ordering. NHP can be billed for administration of the drug.
- Learn more about specific details on authorization criteria, how to request an authorization, and the approval process.
If you have any questions about this process, please call the NHP Provider Service Center at 855-444-4NHP (4647) (toll-free).
Sleep Management Solutions
Effective May 1, 2012, NHP is partnering with Sleep Management Solutions (SMS) to provide sleep diagnostic and therapy management services for all NHP product lines.
- For more information, read the Provider Notice
- To enter an NHP Sleep Authorization or to access the NHP Program Overview Training Module, visit Sleep Management Solutions.
Important Notice About National Drug Code
On February 1, 2012, in an effort to comply with MassHealth regulations, NHP sent communication indicating National Drug Code (NDC) would be required on claims effective April 1, 2012. Although this is a state requirement, we are sensitive to the challenges providers are facing with implementation. NHP and other MCO's are working directly with MassHealth to clarify the implementation timeframe.
As of April 1, 2012, NHP will accept NDC on claims. However, we will not deny claims without them until we receive further clarification from MassHealth. We expect to have more information over the next few weeks and we will communicate a new effective date once one is determined.
Effective December 1, 2011 the number to reach NHP's service representatives is (855) 444-4NHP (4647) and our hours of operation will be 8:30 am to 5:00 pm Monday through Fridays.
On Thursdays our call center closes briefly between 3:00 and 4:00 pm for training purposes. As always, providers have instant access to claims status, eligibility, EOP copies and other information around the clock via our provider portal, NHPNet.
Are You Ready for ICD-10?
To help providers meet the ICD-10 compliance date of October 1, 2013 and avoid multiple survey requests, MassHealth and several Massachusetts health plans are collaborating to conduct an online ICD-10 provider progress survey to help assess statewide compliance efforts underway. To streamline this data collections, HealthCare Administrative Solutions (HCAS) has developed a survey on behalf of several payers, including NHP.
For additional information and to access the survey, click here.