Neighborhood has implemented a new core health plan administration system, HealthRules® by HealthEdge™.

HealthRules allows Neighborhood to provide more consistent and responsive answers to Claims, Authorizations and Customer Service requests. In addition, HealthRules meets new HIPAA 5010 EDI and ICD-10 requirements, and offers Neighborhood flexibility in the face of the changing health care marketplace.

Below are documents that describe parts of the HealthRules implementation and how it may affect you. We have also established an email address, newsystemquestions@nhpri.org, for any questions you have about this implementation.

Special Announcement: February 2012

Core System Changeover

Thank you for your generous patience with us as we work through the glitches associated with our core system changeover.

We have uncovered some issues with our remittance advices. Specifically:

• The totals on the RA do not always match the payment amount, and/or
• The claims listing is not in alphabetical order, and/or
• The reason codes may not clearly explain how the claim was adjudicated

We understand the difficulty this is causing and we are currently developing software patches to resolve these issues. In order to alleviate some of the confusion, we will be sending reports to help affected providers reconcile the mismatched payments/RAs.

Due to the increase in call volume, we have added a new fax line for your claims/inquiries. This new fax number is 401-709-7090; faxes received will be addressed within 48 hours.

Moving to a new system has been a bit more cumbersome than we hoped, but we are confident we are moving in the right direction and system-related issues will be resolved soon.

Thank you again for your partnership.

General Announcements