Neighborhood Health Plan. May 18, 2017

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1 Neighborhood Health Plan May 18, 2017

2 Discover why more members are choosing NHP

3 NHP Products NHP Product Name NHP Connect NHP Prime Line of Business MassHealth Qualified Health Plan (QHP) Commercial Standard CommonHealth CarePlus Family Assistance via Health Connector (Commercial) HMO ConnectorCare via Direct Market HMO PPO

4 Commercial ID Card NHP Prime HMO Green Banner NHP Prime PPO Green Banner PHCS Logo (upper right hand corner)

5 Qualified Health Plan NHP Prime HMO Green Banner MA Health Connector Logo

6 MassHealth ID Card NHP Connect Blue Banner

7 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

8 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

9 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.

10 Authorization and Referrals All authorizations can now be submitted electronically through NHPNET This will increase transparency with authorization request and status

11 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)

12 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

13 NHPNet Questions For all your questions related to NHPNet access or the authorization/referral submission process, please

14 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

15 Claims Process Reminders Appeals and Claims Correspondence: Fax Number: NHP s new address: 399 Revolution Drive Suite 940 Somerville, MA Do not send correspondence to the PO Box address Some simple claims adjustments or questions: providerservice@nhp.org Call:

16 Electronic Funds Transfer Stop receiving paper checks! NHP has partnered with Change Healthcare to simplify EFT registration & payment 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 Register today at:

17 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)

18 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!

19 Provider Enrollment Portal NHP now offers a new self-service online provider enrollment management tool through NHPNet Ability to track request status and receive 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!

20 Provider Enrollment Portal

21 Contacting NHP Provider Services Provider Services (M-F 8 a.m.-6 p.m.) NHPNet Support prweb@nhp.org Provider Enrollment & Credentialing pec@nhp.org

22 Thank you!