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Provider Appeal Guidelines

WEBProvider Appeal Guidelines Effective 1/1/2021 | Rev. 11/1/2023 | Health New England 3 Appeals after Submission to an Alternate Payer HNE may grant an …

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UTILIZATION MANAGEMENT

WEBUTILIZATION MANAGEMENT Effective 1/1/2021 | Rev. 9/1/2021 | Health New England 4 Inquiring about the Status of a UM Decision Practitioners have direct …

Category:  Health Go Health

Web Portal powered by WebMD ONE Healthy Directions

WEBHealthy Directions Portal. EXPERT HELP AND GOAL SETTING. A one-stop wellness shop for Health New England members, the Health New England Healthy …

Category:  Health Go Health

Claims Submission and Reimbursement

WEBClaims Submission and Reimbursement Effective 1/1/2021 | Rev. 11/1/2023 | Health New England 2 CLAIMS SUBMISSION Claims Procedure HNE accepts the …

Category:  Health Go Health

Professional Credentialing & Recredentialing

WEBUse the links below for assistance in getting started with the credentialing process or for more information if you are recredentialing. You also may contact the …

Category:  Health Go Health

HNEDirect Provider Online Services

WEBHNEDirect Provider Online Services Effective 1/1/2021 | Rev. 1/1/2021 | Health New England 2 HNE Providers can now view up-to-date information online …

Category:  Health Go Health

Coordination of Benefits and Subrogation

WEBCoordination of Benefits and Subrogation Effective 1/1/2021 | Rev. 11/1/2023 | Health New England 4 HNE guidelines should always be followed by a …

Category:  Health Go Health

Summary of Benefits and Coverage: What this Plan Covers

WEBAll copayment and coinsurance costs shown in this chart are after your deductible has been met, if a deductible applies. $30 copay/visit Deductible does not …

Category:  Health Go Health

Pharmacy Services

WEBPharmacy Services Effective 1/1/2021 | Rev. 1/1/2021 | Health New England 5 Step Therapy Program Step Therapy is an approach to medication management and …

Category:  Health Go Health

HNE Products and Benefits

WEBHNE Products and Benefits Effective 1/1/2021 | Rev. 1/1/2021 | Health New England 4 Massachusetts Health Connector Plans HNE also offers health benefit plans …

Category:  Health Go Health

Behavioral Health

WEBBehavioral Health Effective 1/1/2021 | Rev. 1/1/2021 | Health New England 2 This section applies to Commercial and Medicare Advantage members only. HNE has …

Category:  Health Go Health

HNE Clinical Guidelines and Standards

WEBHNE Clinical Guidelines and Standards Effective 1/1/2021 | Rev. 1/1/2021 | Health New England 5 Medical records are assessed against the 24 standards listed …

Category:  Medical Go Health

HMO Core 2000 SG

WEBHMO Core 2000 SG (0Y) - 1/1/21 Page 2 of 4 . Benefit Your Cost Outpatient Care PCP Office Visit (Non-Routine) (Deductible may apply to some office services)

Category:  Health Go Health

HDHP HMO SUMMARY OF BENEFIT CHART

WEBPediatic Dental Services Out-of-Pocket Maximum: $350 per child / $700 per family. Total Out-of-Pocket Maximum: $7,500 per individual / $15,000 per family. …

Category:  Health Go Health

HMO Essential 1000 SG

WEBHMO Essential 1000 SG (IF) – 1/1/23 Page 4 of 4 . Benefit Your Cost Behavioral Health (includes Mental Health and Substance Use Disorder) Outpatient …

Category:  Health Go Health

HMO ConnectorCare 3

WEBThis Out-of-Pocket Maximum does not include your cost sharing for pharmacy benefits. $1,500 per individual / $3,000 per family. Pharmacy Out-of-Pocket …

Category:  Health Go Health

HMO Silver A II Connector

WEBHMO Benefit Chart. This chart provides a summary of key services offered by your plan. Consult your Member Agreement for a full description of your plan’s …

Category:  Health Go Health

HMO Thrive Gold 2000 SG

WEBHMO Thrive Gold 2000 SG (VR) - 1/1/21 Page 3 of 4 . Benefit Your Cost Infertility Services Some Infertility services are covered only for Massachusetts and …

Category:  Health Go Health

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