New and Updated Neighborhood Payment Policies

January 2022

Maintaining current and accurate payment polices is a priority for Neighborhood.  We know our provider network relies on policies to inform doing business with Neighborhood.  Please see below for a list of payment policy activity in November and December 2021:

Chiropractic Services Payment Policy 

Action: Created November 2, 2021; Effective December 1, 2021

Summary of changes:

  • Newly created payment policy

Impacted lines of business: INTEGRITY and Commercial

Complementary and Alternative Medicine (CAM) Services Payment Policy 

Action: Reviewed and revised November 2, 2021

Summary of changes:

Impacted lines of business: Medicaid

In Lieu of Services Payment Policy 

Action: Reviewed and revised November 2, 2021

Summary of changes:

Impacted lines of business: Medicaid and INTEGRITY

Immunization and Vaccine Payment Policy 

Action: Reviewed and revised November 12, 2021

Summary of changes:

  • Revised to include guidance that was formerly documented in the COVID-19 Vaccine Payment Policy, now COVID-19 Vaccine Payment Policy – Archive 5, effective September 27, 2021 through November 11, 2021.
  • Added pediatric COVID-19 vaccine and administration codes. Pediatric counseling codes for COVID-19 vaccine are now documented in Neighborhood’s Children’s Care Services Payment Policy.
  • Added Moderna and Janssen COVID-19 vaccine booster codes.
  • Updated COVID vaccine/administration requirements for INTEGRITY members. Effective January 1, 2022 vaccine codes will not be reimbursed, as all vaccines will be provided at no cost to providers through the federal government.  Providers should not bill Neighborhood for any INTEGRITY members. If a claim is sent to Neighborhood, it will be denied. Neighborhood is requiring that providers continue to bill vaccine CPT codes for the purposes of data collection. Vaccine administration codes will be covered and separately reimbursed according to the codes identified in the policy.

Impacted lines of business: All

COVID-19 Vaccine Payment Policy – Archive 5 

Action: Reviewed and retired November 12, 2021

Summary of changes:

Impacted lines of business: Medicaid

Mammography Screening Payment Policy

Action: Reviewed and revised November 30, 2021

Summary of changes:

Impacted lines of business: All

Children’s Care Services Payment Policy 

Action: Reviewed and revised December 3, 2021

Summary of changes:

Impacted lines of business: Medicaid and Commercial

Telemedicine/Telephone Services Payment Policy 

Action: Reviewed and revised November 30, 2021; Effective January 1, 2022

Summary of changes:

Revised to include guidance that was formerly documented in the following separate payment policies:

Impacted lines of business: All

Neighborhood appreciates your continued partnership as we prioritize, create, and/or update provider payment policies.