Neighborhood News
Announcements
- Members Stay with Neighborhood – We thank YOU!
- Provider Manual– Revised April 6 and March 16, 2022; Click here for a summary of changes.
- Provider Screening Requirement for Compliance with 21st Century Cures Act
Reminders
Payment Policies
Quality Improvement
- New and Updated Clinical Resources for Providers
- HEDIS® Care for Older Adults (COA) Measure Criteria
Behavioral Health
Claims
- Claims Corner: Adjustments, Reconsiderations, and Submission Requirements
- Timely Filing and Claim Review Timeframes
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 page.
- Requests for Out of Network Pharmacy Services
- Medicaid Medical Pharmacy Benefit Changes
- Long Acting Insulin Products – Semglee, Insulin Glargine YFGN, Semglee YFGN
- Botulinum Toxin Products – Pharmacy Benefit Only
- Infliximab Products – Home Infusion Requirement for Medicaid Members
- Erythropoiesis-Stimulating Agent (ESA) Backorder
- Preferred Glucagon-like Peptide-1 Receptor Agonist
- Searchable Formulary for Pharmacy Benefit and Medical Pharmacy Medications
- Prescription Drug Coverage in Assisted Living and Long-term Care Facilities
- Opioid Prescribing and Alternative Therapies for Neighborhood INTEGRITY (Medicare-Medicaid Plan) Members
- Medical Benefit Prior Authorization Submissions
- How to Bill 340B and NDC Reminder
- Electronic Prior Authorization (ePA) for the Pharmacy Benefit
- 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.
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.
Last updated: August 22, 2023 @ 6:30 pm