Skip Ribbon Commands
Skip to main content

Provider Payment Guidelines

Our Provider Payment Guidelines make it easy for providers to know exactly what medically necessary services are covered, and under what conditions.*

Payment guidelines answer common provider questions and give information on:

  • Payment guidelines
  • Prerequisites, if applicable
  • Procedure codes (and their descriptors)
  • Limitations
  • Exceptions to policy
  • Member cost-sharing
  • Definitions
  • What NHP reimburses
  • What NHP does not reimburse

To inquire on guidelines not listed here, please e-mail your Provider Relations Representative directly, or call our Provider Services line at 855-444-4647 for verification that a service is covered for a specific member.

MassHealth Reimbursement

For services rendered to NHP’s MassHealth members, the reimbursement of codes aligns with MassHealth reimbursement guidelines. For reimbursement information, please refer to sub-chapter 6 in MassHealth’s Provider Manuals.

Find a Payment Guideline from our alphabetical list:

*These guidelines are not intended to certify coverage availability. The definition of the term "medical necessity" is the definition contained in the Neighborhood Health Plan (NHP) Provider Manual in effect on the date of the medical service in question. The foregoing guidelines may be amended or rescinded at any time by NHP and NHP shall have the exclusive right to interpret and enforce its terms. While services or technology may be determined by NHP as medically necessary, it may not be part of a member's benefit plan. Click here to view NHP plan materials and benefit summaries or call our Customer Service Center at 1-855-444-4NHP (4647) for verification that a service is covered for a specific member.

Join NHP's Provider E-News Community!

Receive news and updates about health care reform, clinical coverage, NHPNet and other important information in a streamlined easy-to-read digital format.

Follow us on

Twitter LinkedIn