Neighborhood News
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Announcements
- Advanced Practice Provider Reimbursement Methodology Update
- Authorization Requirement Update – Interventional Cardiology (Medicaid)
- Coding Change for Home Health Aide Services – Commercial
- COB Submission Process for CCBHC Claims
- Hearing Aid Repair Claims Requiring Invoice Documentation
- Medicaid Six-Month Renewals
- No Prior Authorization Requirement for Services Ordered by PCPs
- Prior Authorization Status Tool Now Available in NaviNet
- The Brenda Seagrave-Whittle Social Worker Award
- Update to 835 Reporting for INTEGRITY for Duals Claims
D-SNP Billing Guidance
- CCBHC Billing Guidance Update
- D-SNP Institutional Sample UB-04 Claim Forms Available for Home Health
- D-SNP Institutional Sample UB-04 Claim Forms Available for Skilled Nursing Facilities
- Skilled Home Health Claims Submission Guidance for INTEGRITY for Duals
- Skilled Nursing Facility Claims Submission Guidance for INTEGRITY for Duals
Member Billing
- Important Reminder: Do Not Bill INTEGRITY for Duals Members for Cost Share
- Updates to Patient Responsibility Information on the RA/EOP
Payment Policies
- Home Health Care Services Payment Policy Updates
- Update to Multiple Procedure Payment Policy
- Updated Payment Policies INTEGRITY for Duals and Dual CONNECT
Pharmacy
- Commercial Pharmacy Benefit Updates
- How to Bill 340B Appropriately
- Medicaid and Commercial Limited Specialty Pharmacy Network Coverage Update
- Prescription Drug Coverage in Assisted Living and Long-Term Care Facilities
- Specialty Medication Prior Authorization Criteria
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.
Quality Improvement
- Coding for Eye Exams for Patients with Diabetes
- HEDIS SAA Measure Adherence to Antipsychotic Medications
- Kratom Legalization in Rhode Island Clinical Considerations and Member Impact
- Statin Therapy for Patients with Diabetes
Reminders
- Deemed Eligibility Coverage Reminders
- Home Infusion Billing Reminder for D-SNP Claims
- Medicare Beneficiary Identifier (MBI) on MDS Assessments in Skilled Nursing Facilities
Risk Adjustment
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.