Neighborhood News
Announcements
- Updated Provider Manual – Effective January 1, 2022
- Open Enrollment for Neighborhood Commercial Plans
- New Commercial Product Benefit in 2022 – Interpreter Services
- Provider Screening Requirement for Compliance with 21st Century Cures Act
- Local Homeless Shelters
- Claim Processing System Upgrade for Improved DRG Reimbursement
- Updated Gateway for Clearinghouse Users
Reminders
- Nursing Home Discharge Transportation
- Education for Neighborhood Members
- Updated Timeframes for Claim Submission and Review Processing
- Requests for Multiple Claim Adjustments – Email submission will no longer be available after January 3, 2022
Payment Policies
- New and Updated Neighborhood Payment Policies
- Revised Vision Care Services Payment Policy – Effective March 1, 2022
Behavioral Health
- Initiation and Engagement of Alcohol and Other Drug Dependence Treatment
- Behavioral Health Identification, Treatment and Referral in Primary Care: On-demand Training Series
Quality Improvement
Claims
- Claims Corner: Submission Requirements, New eForm for Reconsiderations, Adjustments, and More
- Provider Claim Dispute & Provider-initiated Appeals – New eForm
Pharmacy
- 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/
- Medicaid Medical Pharmacy Benefit Changes – Botulinum Toxin and Infliximab Products
- Searchable Formulary for Pharmacy Benefit and Medical Pharmacy Medications
- Prescription Drug Coverage in Assisted Living and Long-term Care Facilities
- Opioid Prescribing and Alternative Therapies for Neighborhood INTEGRITY (Medicare-Medicaid Plan) Members
- Medical Benefit Prior Authorization Submissions
- How to Bill 340B and NDC Reminder
- Electronic Prior Authorization (ePA) for the Pharmacy Benefit
- Dispensing Pharmacy Notification for State-Supplied Vaccines
- 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.
The News and Updates section of the Neighborhood website is used to share important news and information, including notifications on payment policies, operational issues, and more.