Neighborhood Health Plan May 18, 2017

Discover why more members are choosing NHP

NHP Products

Line of Business

Product Name

NHP

NHP Connect

MassHealth

NHP Prime

Qualified Health Plan

(QHP) Commercial

• Standard • CommonHealth • CarePlus • Family Assistance

via Health Connector (Commercial) • HMO • ConnectorCare

via Direct Market • HMO • PPO

Commercial ID Card

• NHP Prime HMO

– Green Banner

• NHP Prime PPO

– Green Banner

– PHCS Logo (upper right hand corner)

Qualified Health Plan

• NHP Prime HMO

– Green Banner

– MA Health Connector Logo

MassHealth ID Card

• NHP Connect

– Blue Banner

2017 Pharmacy Copays

NHP Prime plans (Commercial and QHP) for individuals, families, and small businesses now waive the copays for 11 common medications for chronic conditions

Verifying Eligibility

• Always verify member eligibility prior to rendering care

• Qualified Health Plan (QHP) members:

– Required to pay monthly premiums through the Health Connector

– For non-payments, members have a 3-month grace period:

• Month 1 – Active eligibility, claims process normally

• Months 2 & 3 – Eligibility will appear as “Active – Pending Investigation”, claims will pend

Temporary MassHealth Enrollment Freeze of New NHP Members

• NHP has been the fastest growing MCO in Massachusetts

• We continue to experience material losses in the MassHealth line of business

• After considering many other options to address this situation, NHP and MassHealth implemented a temporary enrollment freeze for new MassHealth members joining NHP

• This option ensures no disruption for our existing MassHealth members.

Authorization and Referrals

• All authorizations can now be submitted electronically through NHPNET

• This will increase transparency with authorization request and status

Network Trainings and Webinars

• Over 3,100 providers participated in an NHP webinar in 2016

• We will continue to expand offerings in 2017

• Webinar included topics such as authorization updates and new provider technology demos

• We hope that your staff can join an upcoming training (future trainings will be announced in the newsletter and NHPNet)

Provider eNewsletter

• The provider eNewsletter is a central place to get the latest news and updates from NHP

• Includes both important clinical and operational updates

• Sign up today on NHP.org/provider

NHPNet Questions

• For all your questions related to NHPNet access or the authorization/referral submission process, please email:

prweb@nhp.org

DRG/EAPG

• We are currently working on transitioning hospitals onto DRG/EAPG methodology

• More information to come!

• If you have any questions, contact Provider Services

Claims Process Reminders

Appeals and Claims Correspondence:

• Fax Number: 617-526-1902

• NHP’s new address:

399 Revolution Drive Suite 940

Somerville, MA 02145

• Do not send correspondence to the PO Box address

Some simple claims adjustments or questions:

• Email: providerservice@nhp.org

• Call: 855-444-4647

Electronic Funds Transfer Stop receiving paper checks!

NHP has partnered with Change Healthcare to simplify EFT registration & payment

Register today at: https://providernet.adminisource.com

Register on Change Healthcare’s ProviderNet You will need the following information: • Your organization’s NPI & Federal Tax ID • Your bank/financial institution’s routing

number & your account number • A recent check from NHP

MassHealth Coverage

• NHP now aligns coverage of codes for our MassHealth line of business with MassHealth’s payment guidelines

• NHP will only reimburse for services that MassHealth determines are payable

• Coverage for some 2017 codes are currently being determined by MassHealth

• Refer to MassHealth payment guidelines for the latest information (subchapter 6 in MassHealth’s Provider Manuals)

http://www.mass.gov/eohhs/gov/laws-regs/masshealth/provider-library/provider-manual/

Coming Soon! NHP’s Enhanced Provider Directory

• NHP is launching a new online provider directory this summer

• New user-friendly interface to help members easily search our provider networks, as well as other enhanced capabilities

• Stay tuned for more information!

Provider Enrollment Portal

• NHP now offers a new self-service online provider enrollment management tool through NHPNet

• Ability to track request status and receive email notification when requests are completed

• Online Requests include: – Enroll new providers to your group – Terminate existing providers – Open and close PCP panels – Submit demographic changes

• After you submit an online request, an HCAS form can be auto-generated for you to send to other health plans

• Contact prweb@nhp.org for questions and to get access today!

Provider Enrollment Portal

Contacting NHP

Provider Services providerservice@nhp.org

Provider Services

1-855-444-4647 (M-F 8 a.m.-6 p.m.)

NHPNet Support prweb@nhp.org

Provider Enrollment & Credentialing

pec@nhp.org

Thank you!