Doing good makes for a healthier and happier heart
Altruistic behaviors promote sharing and cooperation. This can help societies or groups survive crises like food shortages or natural disasters. But what about those acts of altruism where nothing can be gained? Why does somebody give when there is nothing to receive in return? “Finding joy in helping others is fundamental to who we are as a species,” said Elizabeth Dunn, a Professor of Psychology at the University of British Columbia.
Two studies conducted by Professor Dunn and her colleagues confirm the theory. A small study published in Science Journal in 2009 and a larger one published 2019 Journal of Personality and Social Psychology, gave participants a small amount of money ($5 or $20). Then, they told them to spend it on themselves or someone else. People who spent the money on someone else reported being happier than those who spent it on themselves, regardless of the amount. Read more.
Contact
MGBHP Provider Service Team assists our provider community with the following inquiries:
• General questions around provider participation status
• Member benefits
• Claim request for review/appeals
• Authorization requirements/escalations
• Medical drug specialties
• Other inquiries related to MGBHP policies and procedures
Phone: 855-444-4647
Email: HealthPlanProvidersService@mgb.org
MGBHP Provider Relations works in partnership with provider offices to build and maintain positive working relationships and respond to the needs of contracted providers and assist with any training and education. Provider Relations can also assist with escalations.
Email: HealthPlanProvRelations@mgb.org
Provider Portal: Register for the portal to complete the following tasks:
• Benefits and cost sharing
• Claims status
• Member eligibility
• PCP changes
• Authorization submission
• EOP
• And more
Register and access the portal here: Provider.MGBHP.org
In this issue:
- Training series: Integration of behavioral health services into the clinical primary care setting
- ACO Spotlight: New MassHealth doula services program
- Save the date: Spring regional provider meeting on May 20
- Annual CAHPS survey on its way to Medicare Advantage members
- Video: Submitting claims and claims reviews in the Provider Portal
- Care Management at Mass General Brigham Health Plan
- Launch date change: Home health authorization update
- Non-MGB provider language services notification
- Multiple procedure reduction rule in progress, expected completion in April
- Help us keep directory information up to date
- Medicare Advantage FQHC billing guidelines
- Medical policy updates
- Drug code and code updates
- Medicare prior auth update
- Formulary updates
Training series: Integration of behavioral health services into the clinical primary care setting
Mass General Brigham Health Plan would like to share a training series offered through Optum Health Education. This series offers free CMEs and is a three-part on-demand series for behavioral health identification, treatment, and referral in primary care. In addition to this series, many other free trainings on a wide range of topics can be found at Optum Health Education.
The target audience for the trainings include but is not limited to primary care physicians, PAs, nurses, nurse practitioners, social workers and psychologists who are interested in best practices for the integration of behavioral care into a primary care setting.
ACO Spotlight: New MassHealth doula services program
MassHealth has created a new maternal health service! Doula services are now covered by Mass General Brigham Health Plan for expecting mothers who are Medicaid patients. Doulas are non-medical maternal health advocates trained to provide emotional, physical, and informational support during pregnancy, labor, birth, and postpartum. Studies show that the use of doulas produce positive outcomes such as lower C-section rates, improved maternal postpartum mental health, and better patient/doctor communications. Please help us boost awareness about the new MassHealth doula services program by sharing information about this new benefit with your Medicaid patients. You can find more information about the program and guidance on how to enroll patients into the program using the resources below.
MassHealth doula services resources:
- MassHealth doula program webpage: MassHealth Doula Services Program: Information for MassHealth Members | Mass.gov
- MassHealth doula program general information flyer: Download
- MassHealth doula Program Information for Medicaid members: Download
- MassHealth doula directory: Download
Save the date: Spring regional provider meeting on May 20
We're excited to invite you to our spring regional provider meeting on Tuesday, May 20, from 9 a.m. to 12 p.m. at our Assembly Row headquarters in Somerville, MA. Keep an eye out for the formal invitation and schedule, which will be coming your way soon!
Annual CAHPS survey on its way to Medicare Advantage members
It's that time of the year again! The annual Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey or member experience survey is on its way to our valued Medicare Advantage members, courtesy of the Centers for Medicare and Medicaid Services (CMS). This survey is a powerful tool that captures our members' perceptions of their health plan and the healthcare services they've received from July 1, 2024, onwards.
This is a great opportunity to gain insights into our members' experiences. The survey will help us understand various aspects of patient care, including:
- Access to care
- Patient-provider communication
- Care coordination
- Prescription drug access
Your dedication to providing exceptional care and creating a comforting experience for our members is truly appreciated. We're here to support you every step of the way in this collaborative effort. If any of your patients mention receiving the CAHPS survey, we kindly ask that you encourage them to complete it. Their feedback is invaluable in helping us continually improve our services and ensure the best possible care for all our members.
As your trusted partner in this endeavor, we're excited to share that we'll be providing additional tips and information in our April 2025 newsletter. Together, we can make a real difference in the lives of those we serve.
Thank you for your continued commitment to excellence.
Video: Submitting claims and claims reviews in the Provider Portal
We’re excited to announce you can submit claims and claims reviews in the Provider Portal. When submitting a claim or claim review, a transaction number confirming receipt of submission will be available and providers can track the status of a submission within the Provider Portal. Please note, a claim review form must be completed and attached to the online claim review submission. Please review the video walkthrough of the new features below or read the overview. If you need assistance with the Provider Portal, please contact HealthPlanprweb@mgb.org.
Care Management at Mass General Brigham Health Plan
Mass General Brigham Health Plan care managers educate members and ensure they receive the necessary support while addressing their health concerns.
Our care managers will provide guidance to members regarding their discharge plan, including:
- Confirming the member's understanding of the discharge plan
- Educating members about their prescriptions and their importance
- Assisting members in scheduling follow-up appointments with their primary care provider or specialist
- Checking if members need resources to help with self-care at home
- Evaluating the social aspects of members' lives to assess their needs
The care management program also includes specialized case managers, such as nutritionists and rehabilitation specialists, with whom members can directly discuss their care. To learn more, visit our Care Management page.
- Please email referrals to Care Management at healthplancaremanagement@mgb.org
- To connect with our Tobacco-Cessation specialist, please email HealthPlanQuitSmoking@mgb.org
Launch date change: Home health authorization update
The December launch date for our home health authorization update has moved to Monday, April 7. We apologize for any confusion this has caused. As previously announced, the way you enter homecare authorizations through the Provider Portal will be updated. This will impact homecare authorization requests placed through the Provider Portal. Providers will have to submit a separate request for each discipline.
For example, skilled nursing, physical therapy, and occupational therapy, if requested at the same time for the same period, would require separate entries through the Provider Portal. The only exception will be Skilled Nursing and Medication Administrative Visits (MAV) which will need to be submitted together for the MGB ACO line of business.
Inputting a separate homecare authorization for each service being requested will help enhance the current provider claim and authorization process.
Non-MGB provider language services notification
Great news, Mass General Brigham Health Plan is now offering non-MGB providers access to language services. If you are a provider in need of this service, please call the LanguageLine phone line at 844-641-3553 to receive telehealth language services. Instructions on the steps to take to set up language services can be found below along with the various languages in which services are offered. Please note, this service is only for non-MGB providers and must only be used to set up language services for ACO patients. We appreciate all of the work you do and hope this new service will be beneficial to your practice.
Instructions for setting up language services
Information about the array of languages covered through LanguageLine
Multiple procedure reduction rule in progress; expected completion in April
Mass General Brigham Health Plan’s update to its multiple procedure reduction rule remains in progress and is expected to be completed by April 30, 2025. Any impacted claims processed prior to the implementation date will be reprocessed to pay appropriately.
Multiple procedure reduction rule: When multiple surgical procedures are performed in the same operative session, the procedure with the highest RVU will be reimbursed at 100% of the allowed amount and all subsequent, lower RVU-valued procedures, will be reduced per the Plan’s Modifiers Provider Payment Guidelines, unless otherwise specified in the provider’s contract.
Medicare Advantage FQHC billing guidelines
It has come to our attention that some Federally Qualified Health Centers (FQHCs) are not submitting bills for Medicare Advantage in compliance with CMS billing guidelines and Mass General Brigham Health Plan billing instructions. Kindly review the guides below and reach out to Provider Relations if you have any questions:
Medicare Advantage FQHC/RHC billing guide
Provider payment guidelines: Community health centers
Medical policy updates
Forty (40) medical policies were reviewed and passed by the Mass General Brigham Health Plan’s Medical Policy Committee. View a summary of the updates here. These policies are now posted to MGBHP.org.
For more information or to download our medical policies, go to https://www.MGBHP.org/providers/medical-policies and select the policy under the medical policy listings.
Drug code and code updates
View code updates for March 2025 here.
Medicare prior auth update
Part B changes
- Effective 5/1/2025, the following code will require prior authorization before they will be covered under a member’s Part B medical benefit. This change will impact the Mass General Brigham Advantage Secure (HMO-POS), Mass General Brigham Advantage (PPO), and Mass General Brigham Advantage Premier (PPO) plans.
|
Code |
Code Description |
Drug Name |
|
J9299 |
injection, nivolumab, 1 mg |
Opdivo Qvantig |
Formulary updates
View the formulary updates here.