Payment Policy Update

April 2021

Neighborhood understands the important role payment policies have in maintaining a successful business relationship with our providers.

Last year, Neighborhood established a cross-functional committee to review and approve payment policies.  With the pandemic, six (6) temporary payment polices related to COVID-19 were created and updated as State and Federal guidance changed.   In addition to the temporary COVID-19 policies, Neighborhood updated and or created the following payment policies in 2020:

Adult Day Health Services Payment Policy   In Lieu of Services Payment Policy
Complementary and Alternative Medicine (CAM) Services Payment Policy Multiple Procedures Payment Policy
COVID-19 Vaccine Payment Policy Physical and Occupational Rehabilitation Services Payment Policy
Extended Family Planning (EFP) Services Payment Policy Provider Preventable Condition Policy
Home Health Care Services Payment Policy Speech Therapy Services Payment Policy


Even with the above accomplishments, Neighborhood made a commitment in 2021 to continue to make accurate and complete payment policies a priority for our network.   We recently hired two full-time employees, dedicated to payment policy work.    With the committee and new staff resources, Neighborhood’s goal this year is to review all current payment policies.  This comprehensive assessment will determine next steps, including a prioritization order and timelines for revisions.

Recently, Neighborhood updated its payment policy for Non-Covered Services.  The revised version of the payment policy includes minor updates, but it was a major effort in aligning all current internal and external documentation. This will ensure both providers and staff have the same “source of truth” and improve our ability to assist you with inquiries related to exclusions.  The Non-Covered Services payment policy will be frequently revised as we continuously evaluate covered versus non-covered services, but this version includes the following updates:

  • “Cosmetic Surgery” section was edited with additional language to clearly define what is considered cosmetic
  • Medical Marijuana was added to the “Additional Coverage Exclusions” section
  • “Coding” section updated to remove the hyperlinks to code lists by lines of business and replaced with a listing of non-covered codes by line of business, at the end of the revised policy

Neighborhood is dedicated to improving the provider experience for our network.  We look forward to a productive and successful year with our valued provider partners.