Neighborhood News
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Announcements
- Neighborhood Aims to Make Prior Authorization Requests More Efficient
- PCP/Pediatric Provider Questionnaire on Behavioral Health Treatment and Referrals
Reminders
- Medicaid Eligibility Redetermination
- Free Pyx Health App Helps with Feelings of Loneliness and Depression
- The Importance of Keeping Your Practice Information Up-to-Date
- Provider Satisfaction Survey Reminder
Payment Policies
Quality Improvement
Medical Management
Behavioral Health
- Annual Testing and Monitoring for Patients with Schizophrenia
- Behavioral Health News and Resources
- Certified Community Behavioral Health Clinics (CCBHCs)
- Recoupment Letter Issues
Claims
- Claims Corner
- Claim Adjustment Requests
- Claim Submission Reminders for Providers and Billers
- Current Forms
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/
- Cure’s Act – Screening of Medicaid Providers
- Electronic Prior Authorization (ePA) for the Pharmacy Benefit
- How to Bill 340B Correctly
- Medicaid Medical Pharmacy Benefit Changes
- Erythropoiesis-Stimulating Agent (ESA) Backorder
- Medical Benefit Prior Authorization Submissions
- No-Cost, At-Home COVID-19 Test Kits
- 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
- Requests for Out of Network Pharmacy Services
- Searchable Formulary for Pharmacy Benefit and Medical Pharmacy Medications
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.