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January 2023

Neighborhood News

Each article below is hyperlinked to a pdf/printable version of the publication.  If you would like to receive this newsletter via email, please click here to register and Neighborhood News will be delivered straight to your inbox.  Registering your email for Neighborhood News will ensure you receive critical news and information on matters such as new initiatives, policy changes, and much more.

Announcements

Reminders

Payment Policies

Quality Improvement

Medical Management

Behavioral Health

Claims

  • Claims Corner
    • Claim Adjustment Requests: Delay in processing and eForm guidance
    • Claim Forms: Guidance and revised Claim Form Finder
    • Coordination of Benefits
    • Claim Submission Reminders

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/

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.