At Health New England, we want our members to know there are alternative methods for managing pain than just simply using medication. While we understand the need for some medication, we want providers to be aware of the various options our plans offer for pain treatment.

We hope the following information will support discussions with your patients, who are also Health New England commercial plan members, about their options.

Pain Management Alternatives offered by Health New England:*

• Acupuncture
• Massage Reimbursement
• Chiropractic
• Physical Therapy
• Occupational Therapy
• Cognitive Behavioral Therapy (no benefit limit)
• Nutritional Counseling (4 preventive visits)
• Osteopathic Manipulative Medicine
• Interventional Pain Management: Nerve Block, spine surgery, transcutaneous electrical nerve stimulation (TENS) unit

*Coverage and/or number of visits may vary depending on plan type.

Health New England is excited to announce a new, cutting-edge pharmacy transparency service called Rx Savings Solutions. This new service partner helps patients/members find the lowest-cost prescription drug, according to their own health plan. It empowers both providers and patients with the information needed to select the most cost-effective, yet therapeutically-conscious, prescription medication for the patient. The patented software analyzes prescription claims and considers all possible clinical options to save its users money on prescriptions, all within the user’s specific plan design.

Rx Savings Solutions may reach out to providers on behalf of our commercial members by fax. See sample fax .pdf below for reference.

Questions: please reach out to the Rx Savings Solutions pharmacy support team at (800) 268-4476 or email support@rxsavingssolutions.com, Monday-Friday, from 8 a.m. to 9 p.m. ET. For additional information, visit www.healthnewengland.org/rxss.

• Anesthesia services
• Audit program
• Autism professional services
• Bilateral and multiple professional and facility services
• Claims editing
• Counseling and/or risk factor reduction intervention services
• COVID-19 vaccination
• Discarded drugs and biologicals
• Diabetic care
• Drug testing
• Emergency department services
• Evaluation and management
• Genetic testing
• Hospice services
• Immediate post-concussion assessment and cognitive testing (impact) testing
• Individual consideration services (applies to Medicaid only) 
• Inpatient hospital services
• Laboratory professional services new effective 9/1/20
• Mammography services
• Mid-level practitioners
• Modifier new effective 9/1/20
• Newborn and neonatal care
• Non-covered, experimental & investigational services
• Non reimbursed revenue codes
• Neuropsychological and psychological testing
• Nutritional counseling
• Observation services
• Obstetrical care
• Preventive services
• Provider based billing
• Readmission to inpatient level of care
• Serious reportable events / provider preventable conditions
• Skilled home health care
• Skilled nursing facility
• Sleep studies
• Telehealth (telemedicine) services
• Transportation services
• Treatment room
• Unlisted procedures
• Urgent, extended care & walk-in care
• Vaccines and immunizations

ACO Home Care Partnership: With the Accountable Care Organization, there are certain guidelines to follow when requesting services, how to submit requests and billing procedures. In fact, the type of professional services allowed is based on the degree of skills as it relates to the medical necessity of the member. Health New England is here to help you understand and partner for the care of our members. Below is information necessary for you to know.

Requirements and Guidelines: Reference the ACO Home Care Partnership Booklet to learn more about authorization requirements and guidelines around type of services and payment guidelines.

Commonly Used Managed Codes and Descriptions: Reference the Home Care Service Code Description Card to understand the best practices with the various codes used for each services.

Frequently Asked Questions (Coming Soon)