April 2023

Neighborhood News

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Quality Improvement

Payment Policy Updates

  • Telemedicine/Telephone Services Payment Policy
  • Non-Covered Services Payment Policy

Risk Adjustment Coding Corner

  • Commonly Miscoded Conditions
  • “History of” and “Past Medical History”

Claims Corner

  • CMS 1500 Paper Claim Submission Updates for 2023
  • Claim Adjustment Requests
  • Coordination of Benefits
  • Claim Submission Reminders for Providers and Billers
  • Claim Forms

Behavioral Health

  • STAR (Smart Technology Authorization Review)
  • Recovery Connections Centers of America, Inc. Closure
  • Xylazine Emerges in the Illicit Drug Supply


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/

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.