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.
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:email@example.com.
- 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.
Everything new and newsworthy for NHP providers and their practice managers
Welcome, providers and practice managers, to news and updates from Neighborhood Health Plan. We thank you for your attention to these matters, and hope you find this information useful.
Duplicate Checks Sent Out in Error
October 23, 2013
Duplicate checks were sent out in error for claims processed on October 23rd. The issue was identified to be a result of system testing with one of our vendors for claims payment and has since been resolved.
Learn more about what you should do if you receive duplicate checks.
New Plans for the Merged Market
September 19, 2013
In 2014, Commonwealth Care will no longer be available to our members, and Commonwealth Choice and Business Choice plans will no longer be available in the merged market (individuals and groups of 1–50).
In light of these discontinuations, we are pleased to announce that NHP was recently certified as a Quality Health Plan and awarded the seal of approval to offer new, ACA‐compliant plans. We will offer these plans through the MA Health Connector, the direct sales market, and brokers.
Provider Service Line Updates: Extended Hours
We are pleased to announce extended hours for our Provider Service Line 1-855-444-4NHP (4647). Hours of operation are now 8 a.m. – 6 p.m. (Mon-Fri).
New Provider Service Line Prompts
We are making enhancements to our Provider Service Line (1-855-444-4NHP). Beginning mid July 2013, when calling our provider service line, you will receive a prompt to enter your NPI number and the Member ID. These enhancements will assist with timely responses to your phone inquiries.
As a reminder, our provider portal (NHPNet) is available 24 hours a day, 7 days a week to provide access to many transactions within seconds.
Clinical Coverage Criteria Update
The following Clinical Criteria are now available:
Notification of Birth Reminder
MassHealth's enrollment process for newborns (born to mothers enrolled in a Managed Care Organization) requires that the birth facility notify their Enrollment unit via the Notification of Birth (NOB) form.
This form captures demographic information for both mother and child and confirms the mother's health plan selection for the newborn.
We would like to remind network facilities that it’s critical to submit the fully completed NOB to MassHealth in a timely fashion, thereby indicating the health plan chosen by the mother.
Failure to properly notify MassHealth often results in retroactive enrollment changes and the associated post-payment recoveries. While health plans cannot notify MassHealth directly of these newborns, we are currently reviewing the process for alerting facilities of babies born to NHP-enrolled members in hopes of increasing the notification compliance rate.
We ask that you please share this information with relevant personnel within your organization. For questions on completing the NOB, please contact Provider Relations at firstname.lastname@example.org.
Finally, thank you.
On behalf of all of us at Neighborhood Health Plan, we thank you for the excellent care you provide our members, and the collaboration you continue to extend to all our staff.
Provider Relations Department
Neighborhood Health Plan