Healthwise® Care Support Pages
Search over 400 simple patient education sheets on a variety of health topics by category or key terms (available in English & Spanish).
Welcome Providers!
We have made significant progress on identifying the technical issue encountered earlier today with the Authorization and Referral module. Unfortunately, we have been unable to resolve the issue in its entirety. As a result, we are postponing the launch of the Authorization & Referral module on NHPNet at this time.A new go-live date will be communicated to you by Wednesday, February 8.
Please note that NHP will not require referrals for specialty services until the Authorization and Referral module issue has been addressed and the new go-live date has been established and communicated. Again, we apologize for the inconvenience and we understand that this delay has caused disruption for you and your staff.
Please continue to fax authorizations to NHP's existing fax lines until the issue is resolved and a new go-live date has been communicated.
Thank you for your patience. Please contact your NHP Provider Relations Representative if you have any questions.
Referral & Authorization Requirements
Please be aware, effective February 1, 2012, Prior Authorizations for all members and Referrals for MassHealth & Commonwealth Care members must be submitted through NHPNet. Only requests for benefit exceptions, out of network providers and some services can be initiated by fax.
As a precursor to implementation, NHP has developed Quick Start guides to show you how simple it will be to enter authorizations and referrals via the portal. Please review the PDFs below; should you have any questions, please don’t hesitate to contact your Provider Relations Representative.
- Quick Reference Guide – Specialty Referrals
- Quick Reference Guide – Inpatient Admissions
- Quick Reference Guide – Outpatient Care
In addition to the Quick Start Guides, NHP has created a guide showing which services will require electronic submission.
As a reminder, specialty referrals will be required for all specialists except the following:
- A Gynecologist or Obstetrician for routine, preventive, or urgent care
- Family planning services provided by any MassHealth or Commonwealth Care provider
- Outpatient and diversionary Behavioral Health Services
- Emergency services
Please Note:
- NHP will allow primary care providers to request referrals up to 90 days following the date of service.
- Pediatric members who are part of our Special Kids Special Care (SKSC) Pediatric Program are excluded from the specialty referral requirement.
Important Notice About National Drug Code
Effective April 1, 2012 Neighborhood Health Plan will require the 11‐digit National Drug Code (NDC) on all outpatient claims for drugs administered during a patient’s visit in addition to the HCPCS code in order to be compliant with the State regulations.
Contacting NHP
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.
Claims Status Check Made Simple!
Have you heard about the latest enhancements to NHPNet's current Claims Status Inquiry feature? Read our October Provider News to learn more about it!
Revised Companion Guides Now Available
Our 837 Institutional Companion Guide has been updated. Access the new version, including a list of Frequently Asked Questions.
New Redetermination Reports Now Available
The latest NHP Redetermination and Inpatient Admissions reports are now available to primary care offices and hospital facilities respectively. To view these reports, log onto your NHPNet account.
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.
Recent Issues of Clinician Quarterly and Around the Neighborhood
Summmer 2011 Issue of Clinician QuarterlySummer 2011 Issue of Around the Neighborhood.
Look here for recent and archived issues of all provider newsletters.
Provider Manual
The NHP Provider Manual is your resource on doing business with Neighborhood Health Plan
Are you listed correctly in the online Provider Directory?
NHP's online provider directory is updated on a daily basis. Check your listing today and submit updates by email to prweb@nhp.org. Please note: only credentialed providers are listed in the online directory.
Partner Sites
- Beacon Health Strategies
(NHP's Behavioral Health Management Partner) - MedSolutions
(Radiology Prior Authorization) - Healthcare Administrative Solutions
(Administrative Simplification) - NEHENNet (Revenue Management Solution)
- MedMetrics Health Partners (Pharmacy Partner)