Updated Payment and Clinical Policies, Effective October 1, 2017

Fecha: 09/08/17

The following new policies will be applied as medical claims reimbursement edits with our claims adjudication system. This is an addition to all other reimbursement processes that NH Healthy Families & Ambetter from NH Healthy Families currently employs.

The effective date for the below policies is October 1, 2017

• EpiFix Wound Treatment
• Low-Frequency Ultrasound Wound Therapy
• Mechanical Stretch Devices
• Wireless Motility Capsule
• Robotic Surgery
• Inpatient Only Procedures - *Ambetter only*

These policies are developed based on medical literature and research, industry standards and guidelines as published and defined by the American Medical Association’s Current Procedural Terminology (CPT®), Centers for Medicare and Medicaid Services (CMS), and public domain specialty society guidance.

Accessing Payment & Clinical Policies

We are happy to inform you that NH Healthy Families publishes its Payment and Clinical Policies online to inform providers about billing practices and reimbursement methodologies for certain procedures and services. We hope this information will help you to bill claims more efficiently and reduce unnecessary denials and delays in claims processing and payments.

Read the full policy disclosure in the Provider Newsroom on the NH Healthy Families website.

Visit NHhealthyFamilies.com to find NH Healthy Families Payment and Clinical Policies. Policies can be found on the Provider Resources page under Manuals, Forms & Resources.

Ambetter payment policies can be found at Ambetter.NHhealthyFamilies.com on the Provider Resources page.

Please contact Provider Services at 1-866-769-3085 with any questions about the policies.