Neighborhood News
Each article below is hyperlinked to a pdf/printable version of the publication.
Announcements
- The Public Health Emergency and its Impact on Medicaid Eligibility
- Neighborhood’s Special Investigation Unit and Cotiviti
- Southside Community Land Trust – Healthy Food Hub
- New eForm Process for Requesting Interpreter and Language Assistance Services
- Free Pyx Health App Helps with Feelings of Loneliness and Depression
Reminders
Payment Policies
Medical Management
Behavioral Health
Claims
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/
- Medicaid Medical Pharmacy Benefit Changes
- Infliximab Products – Home Infusion Requirement for Medicaid Members
- Preferred Glucagon-like Peptide-1 Receptor Agonist
- Erythropoiesis-Stimulating Agent (ESA) Backorder
- Medical Benefit Prior Authorization Submissions
- Searchable Formulary for Pharmacy Benefit and Medical Pharmacy Medications
- Cure’s Act – Screening of Medicaid Providers
- Requests for Out of Network Pharmacy Services
- Opioid Prescribing and Alternative Therapies for Neighborhood INTEGRITY (Medicare-Medicaid Plan) Members
- Pharmacy Benefit Medicaid Drug Rebate Program (MDRP)
- Prescription Drug Coverage in Assisted Living and Long-term Care Facilities
- Pharmacy Coverage Determination Timeframes
- No-Cost, At-Home COVID-19 Test Kits
- Electronic Prior Authorization (ePA) for the Pharmacy Benefit
- How to Bill 340B Correctly
- 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.