Neighborhood News
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Benefits
Claims
- Coordination of Benefit Claims Now Submitted Electronically
- Updated Terminology for Provider-initiated Appeals
Clinical Prior Authorization
- Home Health Care Prior Authorization Requirement to be Removed
- New Documentation Requirements for Plastic Surgery Procedures
- New Reimbursement Rate for Occupational and Physical Therapy Services
- Documentation Requirements for Pain Management Prior Authorizations
- Vision, Medical Prior Authorization Requirements to be Removed
Payment Policies
Pharmacy
- Cost Saver Program for Commercial Members
- Delegation of Services to Evolent Health
- Electronic Prior Authorization for the Pharmacy Benefit
- How to Bill 340B Appropriately
- Medicaid and Commercial Limited Specialty Pharmacy Network
- Medical Benefit Prior Authorization Submission
- Opioid Prescribing and Alternative Therapies for Neighborhood INTEGRITY Members
- Pharmacy Benefit Medicaid Drug Rebate Program (MDRP)
- Prescription Drug Coverage in Assisted Living and Long-Term Care Facilities
- Reminder: Specialty Medication Prior Authorization Criteria
- Upcoming Medicaid Pharmacy Benefit Changes
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.
Quality Improvement
- Asthma Medication Ratio
- Cervical Cancer Awareness
- Chlamydia Screening in Women
- Follow-Up Care for Children Prescribed ADHD Medications
- Human Papillomavirus: Awareness and Vaccination
- Kidney Health Education for Patients with Diabetes
Reminders
- How Patients Can Keep Their Medicaid Benefits After the “Unwinding” Process
- Provider Training Webinar Coming September 18
- September 2024 Provider Satisfaction Survey
- Update to Neighborhood’s Access to Care Standards for INTEGRITY Members
Risk Adjustment
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.