Health Care Reform Updates and Resources
FAQ: Transition of Care Exception Process for MassHealth and ACA-Compliant Plans (for members with effective dates January 1- April 1, 2014)
|Please Note: For all NHP members, you should always follow the existing NHP policies and procedures as outlined in the NHP Provider Manual. This includes verifying the member’s eligibility and benefit coverage; as well as obtaining necessary authorizations and referrals prior to providing any service.|
What is the transition of care process for current NHP members who select a new NHP product?
NHP will transfer all existing approved authorizations and referrals on file for current NHP members. If a required authorization/referral has not been previously obtained, you can request one through the normal channels.
Will I need to obtain authorizations and referrals for new members transitioning into NHP?
Yes. For all NHP members, you should always verify the member’s eligibility, benefit coverage, and obtain necessary authorizations and referrals prior to providing any service.
Will there be an exception process for claims and authorizations that have been submitted to the wrong carrier?
Yes. We understand that this may be a confusing time for you and your patients. In the event that you obtained authorization and submitted claims to the wrong carrier, NHP will honor claims for services within the member’s benefit coverage for up to 60 days from the member’s effective date with NHP. This exception process only applies to members with an NHP effective date from January 1-April 1, 2014.
For questions related to Transition of Care, who should providers contact?
Please refer to the following page for a list of contacts for questions related to transition of care.
Explanation of Payment Suppression, Electronic Funds Transfer, Electronic Remittance Advice
To support the Affordable Care Act requirements, and eliminate the unnecessary use of paper, NHP is now offering our providers new electronic capabilities. To register for any of these services, go to NHPNet and click on the enrollment link found in the E-Business Tab.
- Explanation of Payment (EOP) Suppression—Providers can request to stop receiving paper EOPs in the mail. Eops can still be viewed and printed any time on NHPNet.
- Electronic Funds Transfer (EFT)—NHP has partnered with Alegeus Technologies to simplify EFT registration and payment. Receiving payments via EFT is a free service in which NHP delivers payments directly to your organization’s bank account – rather than via paper check. Visit the Alegeus ProviderNet site directed by clicking here.
- Electronic Remittance Advice (ERA) —Providers who register for ERAs will stop receiving paper EOPs within 31 days. All providers and designated staff members can view their EOPs at any time on NHPNet.
Transition of Care Process Contact List
Before filing an appeal, please use the information below to contact NHP. A dedicated escalation team is available to assist with transition of care questions.
- For member and provider transition questions: Members and providers should contact our Customer Service line. Members call the number on their identification card. Providers call 1-855-444-4647 (TTY 1-800-655-1761). Providers can also email inquiries to:firstname.lastname@example.org.
- For Behavioral Health matters: Members and providers should contact Beacon’s Customer Service at 1-800- 414-2820 (TTY 781-994-7660).
For Urgent Clinical Authorization matters (for Provider use only):
- For urgent medical and administrative transition matters: Please contact Clinical Service at 1-877-450-9260
- For urgent or escalated Pharmacy Questions: Please contact Cathy Pappas at 617-478-7163 or email Catherine_Pappas@nhp.org.
- For urgent or escalated Behavioral Health matters: Please contact Jim Kaufman at 781-994-7134 or email James.Kaufman@beaconhs.com or Jill Lack at 617-772-5774 or email Jill_Lack@nhp.org.
NHP Health Care Reform Updates
NHP Prime (Commercial) Resources
NHP Connect (MassHealth) Resources