What is Medical Security Program (MSP) Direct Coverage?
MSP Direct Coverage is health insurance for eligible Massachusetts residents who receive unemployment insurance and have an annual family income less than or equal to 400% of the Federal Poverty Level.
What is Network Health's Medical Security Program Direct Coverage plan name?
The new plan name is Network Health Extend.
How will this change affect my patients?
Effective January 1, 2012, Medical Security Program Direct Coverage participants will be transferred automatically to Network Health and will be covered by Network Health Extend.
How do I know if a patient is a Network Health Together®, Network Health Forward®, or Network Health Extend member?
The patient’s ID card will indicate the plan. Network Health Extend is our Medical Security Program Direct Coverage plan, Network Health Forward is our Commonwealth Care plan, and Network Health Together is our MassHealth plan.
You can get patient information with Network Health Connect, our online self-service tool; NEHEN or NEHENnet, if you are a member; or our Interactive Voice Response (IVR) system by calling us at 888-257-1985.
What does the new ID card look like?
The ID card looks like other Network Health ID cards and indicates that the patient is a Network Health Extend member.
Why is the Medical Security Program (MSP) Direct Coverage plan now administered by Network Health?
The Massachusetts Department of Unemployment Assistance selected Network Health through a competitive procurement process to manage the benefits provided to MSP Direct Coverage plan members. Network Health is replacing BlueCross BlueShield as the health insurer for MSP Direct Coverage members.
What do members pay for coverage with Network Health Extend?
Some Network Health Extend members who were previously paying deductibles will pay less. Network Health Extend members will not pay deductibles and will have lower co-payments than they had prior to joining Network Health on January 1, 2012. Some members may be required to pay a weekly premium, based on family income and the number of family members covered who are subject to a premium.
Are other plans managing the Medical Security Program (MSP) Direct Coverage plan as well?
No, Network Health is the only MSP Direct Coverage plan the Department of Unemployment Assistance offers.
How do I become contracted as a Network Health Extend provider?
If you are a provider interested in joining our network, the first step is to submit a letter of interest. Please submit a formal letter of interest to:
Letter of Interest
Attn: Director of Contracting
Network Health, LLC
101 Station Landing, Fourth Floor
Medford, MA 02155
You can learn more about joining our network.
Will I have the same provider relations representative I currently have for Network Health?
Yes. Your provider relations representative will not change.
How and when were providers notified of the product information?
Network Health sent contract addenda for Network Health Extend to targeted provider groups who are already in our network. We also notified individual providers who are contracted with us for Network Health Extend to give more details about the new plan.
What makes a member eligible for Network Health Extend?
The Department of Unemployment Assistance (DUA) determines Medical Security Program (MSP) Direct Coverage, and therefore Network Health Extend, eligibility.
To be eligible for Network Health Extend, a member must:
- Be a Massachusetts resident
- Become unemployed from a Massachusetts employer
- Receive unemployment insurance benefits from Massachusetts
- Have an annualized total family income (for six months prior to application for the MSP plus projected income for the next six months) that’s less than or equal to $43,560 for an individual or $89,400 for a family of four
- Not have access to spouse’s insurance (affordability will be considered)
- Not be enrolled in Medicaid or Medicare Part B
Please refer patients who want more information to the DUA at www.mass.gov/dua/msp or 800-908-8801.
How do I check eligibility?
Always verify a patient’s Network Health eligibility at the time you render services. If you check a patient’s eligibility in advance of an appointment, please also check again on the day of service. You can verify Network Health Extend member eligibility through regular channels, including Network Health Connect, our online self-service tool; NEHEN or NEHENnet, if you are a member; or our Interactive Voice Response (IVR) system by calling us at 888-257-1985.
What are the reimbursement rates for Network Health Extend?
Reimbursement rates are based on each provider’s contractual agreement. For specific information regarding your reimbursement rate, please contact your provider relations representative at 888-257-1985.
Do I handle claims in the same way I currently do with Network Health?
Yes. You will file claims the same way for all Network Health plans, including Network Health Extend.
Will Explanations of Payment (EOPs) look different?
No. The EOP for Network Health Extend will be incorporated into the EOP you currently receive.
How will I know which providers are in- or out-of-network?
You can use our online Find a Doctor, Hospital, or Pharmacy tool to search for in-network providers for
Network Health Extend.
If a PCP refers a Network Health Extend patient to an out-of-network provider, is it the specialist’s responsibility to check member eligibility?
Yes. The provider who is delivering service should check eligibility when the appointment is made and at the time of the appointment. You can verify Network Health Extend member eligibility through regular channels, including Network Health Connect, our online self-service tool; NEHEN or NEHENnet, if you are a member; or our interactive voice response (IVR) system by calling us at 888-257-1985.
Does Network Health Extend cover emergency services at an out-of-network facility?
Yes, Network Health covers all emergency and post-stabilization care for all members at any facility.
If a specialist doesn’t have admitting privileges to an in-network hospital, can he/she still be in-network?
Yes, but the specialist would need to get a prior authorization to refer a member to an out-of-network facility. Please contact your provider relations representative at 888-257-1985 for more information.
If a hospital is out-of-network, are all the physicians who admit there out-of-network too?
It varies for each facility. You can use our online Find a Doctor, Hospital, or Pharmacy tool to search for in-network providers for Network Health Extend.
If I am not in the Network Health Extend provider network and only my facility provides the type of service the member needs, will I get paid?
Yes, if you follow our prior authorization requirements, if applicable. Network Health only covers services at an out-of-network provider if there is a prior authorization on file for the service, or if it’s for an emergency encounter or post-stabilization care. Providers should check eligibility on the date of service, as well as the date the appointment is made, and submit the request for the prior authorization if one is necessary prior to the service.
What should I do if I only have admitting privileges at an out-of-network facility?
Unless you have prior authorization for services at an out-of-network facility, your Network Health Extend patient should go to an in-network facility.
If an out-of-network provider treats a Network Health Extend member, will the provider get paid?
Network Health only covers services at an out-of-network provider if there is a prior authorization on file for the service or if it’s for an emergency encounter or post-stabilization care. Providers should check eligibility on the date of service, as well as the date the appointment is made, and submit the request for the prior authorization if one is necessary prior to the service.
Does Network Health Extend cover out-of-state services?
Network Health requires prior authorization for out-of-state care, except for urgent care and emergency services. Network Health requires prior authorization only for non-emergency admissions for members who are full-time, out-of-state dependent students ages 18 – 26. For additional information, please see the Out-of-state Payment Policy: Full-time, Dependent Students Ages 18 – 26 (Network Health Extend).
I am a PCP on Martha’s Vineyard or Nantucket. Can my patients get services from a Partners Healthcare facility outside of Martha’s Vineyard or Nantucket?
Yes, as of January 1, 2012, Network Health Extend members with a PCP on Martha’s Vineyard or Nantucket can receive services from any Partners Healthcare facility without prior authorization. You can use our online Find a Doctor, Hospital, or Pharmacy tool to search for in-network providers for Network Health Extend.
Do Network Health Extend members require referrals or prior authorizations for services?
Network Health Extend members need prior authorizations for certain services. To find detailed information about prior authorization requirements, please refer to our Network Health Extend Medical and behavioral health benefit summary grids.
Some of your Network Health Extend patients may need a primary care provider (PCP) referral before getting care from a specialist. You can see which Network Health members require a referral for specialty care, and if there is a referral on file, when you check member eligibility with Network Health Connect, our online self-service tool; NEHEN; and NEHENnet, if you are a member. You can also check a Network Health member’s ID card to see if a referral is required, or call us at 888-257-1985.What will happen to prior authorizations approved by BlueCross BlueShield for a service taking place on or after January 1, 2012?
Prior authorizations approved by BlueCross BlueShield prior to January 1, 2012, will not be valid as of January 1, 2012. For detailed information about prior authorization requirements, please refer to our Network Health Extend Medical and behavioral health benefit summary grids. If a service requires prior authorization, please submit a Standardized Medical Prior Authorization Request Form to Network Health, and include the appropriate clinical documentation to support the request. Please contact your provider representative if you have questions about prior authorizations at 888-257-1985.
If I am a primary care provider (PCP), how can I see which Network Health Extend patients are in my panel?
PCPs can access panel reports for Network Health Extend patients by using Network Health Connect, NEHEN or NEHENnet, if you are a member. If you do not currently have a Network Health Connect log-in, you can begin the sign-up process.
Will information about Network Health Extend patients be available on Network Health Connect?
Yes, the same patient information that is available for other Network Health patients is available for
Network Health Extend patients on Network Health Connect.
What are the benefits for Network Health Extend patients?
Network Health Extend covers office visits and screenings, wellness visits for infants and children, hospital care, treatment for mental health and substance abuse, and prescription drug coverage.
You can see detailed information about covered benefits in our Medical and behavioral health benefit summary grids.
What will happen to new and current members who are in active treatment with an out-of-network provider?
The provider should call for an authorization for service. Members are covered by our continuity of care guidelines if:
They are pregnant and in their second or third trimester — they can see their provider until they deliver and have their first postpartum visit within six weeks of delivery
They are terminally ill — they can see their provider while they are sick
They are undergoing current or ongoing treatment, such as dialysis, home health, chemotherapy, radiation therapy, or inpatient level of care at a hospital/facility; they can see the provider throughout treatment or up to 90 days from date of enrollment, whichever is less
They have previously been authorized for health services
It’s their PCP — they can see them for 30 calendar days from date of enrollment
Does Network Health have a continuity of care policy? Can I get a copy?
Yes, Network Health has a continuity of care policy, which is based on Department of Insurance (DOI) regulations. If you would like a copy of the regulations, please contact your provider representative at 888-257-1985.
What are the co-payments for my Network Health Extend patients?
Co-payments will be different for Network Health Extend members than they were prior to January 1, 2012. See the Medical Security Program co-payment grids for more information.