Neighborhood News
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Announcements
- COVID-19 Provider Guidance
- Help Your Medicaid Patients Keep Their Coverage
- Encourage Patient Enrollment in CurrentCare®
- Mandatory RI Medicaid Enrollment for Contracted Providers – Action required by July 1st for Non-Compliant Providers
Reminders
- Neighborhood Policies and Guidelines
- Appropriate Use of Expedited Prior Authorization
- Provider Guidance for Medicaid Members (Adult-Only) Requiring Long-Term Non-Skilled Services
- Annual Mandatory Provider Training Reminder
- Home Care Discharge Communication Form
Quality Improvement
- Metabolic Monitoring for Children and Adolescents on Antipsychotics
- Use of Imaging Studies for Low Back Pain
- HEDIS® Care for Older Adults (COA) Measure Criteria – Updated Provider Guide (March 14, 2023)
- Telemedicine/Telephone Services Payment Policy
- Non-Covered Services Payment Policy
- Commonly Miscoded Conditions
- “History of” and “Past Medical History”
- CMS 1500 Paper Claim Submission Updates for 2023
- Claim Adjustment Requests
- Coordination of Benefits
- Claim Submission Reminders for Providers and Billers
- Claim Forms
- STAR (Smart Technology Authorization Review)
- Recovery Connections Centers of America, Inc. Closure
- Xylazine Emerges in the Illicit Drug Supply
Pharmacy
Monthly Pharmacy Benefit Changes: On a monthly basis, Neighborhood places a list of formulary changes on its website for each line of business. For more information, please visit the Pharmacy Provider Resources webpage at: https://www.nhpri.org/providers/provider-resources/Pharmacy/
- NCH Faxes Lines Have Changed: New eFax Numbers by Specialty
- Medicaid Stimulant Formulary Update
- Cure’s Act – Screening of Medicaid Providers
- Medicaid and Commercial Limited Specialty Pharmacy Network
- Pharmacy Benefit Medicaid Drug Rebate Program (MDRP)
- How to Bill 340B Appropriately
- Electronic Prior Authorization (ePA) for the Pharmacy Benefit – Eliminate hand-written faxed PA requests!
- Medical Benefit Prior Authorization Submissions
- Opioid Prescribing and Alternative Therapies for Neighborhood INTEGRITY (MMP) Members
- Prescription Drug Coverage in Assisted Living and Long-term Care Facilities
- Requests for Out of Network Pharmacy Services
Specialty Medication Prior Authorization Criteria Update: As of February 1, 2021, Prior Authorization Requests for Specialty Medications require submission of the member’s chart or medical record documenting medical necessity based on the criteria corresponding to the indication. The specialty drug prior authorization request will also require submission by the provider’s office and not by a third party.