News from NEPHO – DECEMBER 2022 Edition


Check back next month for new providers.


  • Tina Waugh, MD of Beth Israel Lahey Health Primary Care, Beverly 30 Tozer Road Beverly, MA 01915 will be terming effective 2/10/2023.
  • Daniel Steece, MD of Essex County OBGYN, 480 Maple Street Suite 303. Danvers, MA 01923 will be retiring effective 12/31/2022.


NP/PA Meeting
Date: Wednesday, January 25th, Noon
Speaker: Smita Patel, MD, Psychiatrist
Topic: Bipolar Disorder
Location: Teams Meeting



Below is a list of dates for BILHPN Acuity Training for Epic users and a link to the recording of the September 12, 2022 Session. Click on each date to register.

Provider Acuity Training Series with CME Credit

Click here to request access to view the Recording for the September 12th Provider Acuity Training Series Session

January 31, 2023, from 12 – 1 p.m.

March 7, 2023, from 5:30 – 6:30 p.m.

May 2, 2023, from 12 – 1 p.m. 

July 18, 2023, from 5:30 – 6:30 p.m. 

Arcadia Acuity Trainings

February 8, 2023, from 12:05 – 1 p.m.

May 10, 2023, from 12:05 – 1 p.m. 

August 10, 2023, from 12:05 – 1 p.m. 

November 7, 2023, from 12:05 – 1 p.m.


Blue Cross Blue Shield of Massachusetts

Changes to Products and Benefits for 2023

Beginning January 1, 2023, BCBSMA will make changes to the health plans and benefits. Because of these changes, it is always important to check the patient’s Blue Cross ID card and to verify their eligibility and benefits. To view the complete notification, click here.


The Road to Unwinding: Key Dates and Activities for States

When the COVID-19 Public Health Emergency (PHE) and the Families First Coronavirus Response Act (FFCRA) continuous enrollment condition end, states must return to normal eligibility and enrollment operations. States will have up to 12 months to initiate a full renewal for all individuals enrolled in Medicaid, the Children’s Health Insurance Program (CHIP), and the Basic Health Program (BHP). Once the announcement that the PHE will end occurs, it will trigger the submission of required reporting and other documents to CMS. For additional information, click here.


Upcoming 2023 Telehealth Policy Changes (COVID-19)

The Centers for Medicare & Medicaid Services (CMS) recently published policy updates for Medicare telehealth services. For additional information, click here.

Medicare NCCI Add-on Code Edits

The Add-On Code Edits Implementation for Medicare Effective 01/01/2023 ZIP file has been posted to the website. To view the notification, click here and locate the ZIP file in the related downloads section.

Medicare NCCI Procedure to Procedure (PTP) Edits

CMS posts changes to each of its NCCI PTP published edit files on a quarterly basis. This includes additions, deletions, and modifier indicator quarterly changes to PTP column one/column two correct coding edits and the PTP mutually exclusive code edits for Practitioners and Hospital Outpatient PPS in the Outpatient Code Editor. For the latest updates, click here.

Medicare National Correct Coding Initiative: Annual Policy Manual Update

On December 1, CMS posted the updated Medicare National Correct Coding Initiative Policy Manual effective January 1, 2023. See the policy manual archive on the left side to get prior versions of the manual. To view the notification including a link to the policy manual, click here.

Harvard Pilgrim Health Care

Latest Integration Updates & Webinars

Stay updated on the progress we have made since bringing Harvard Pilgrim Health Care and Tufts Health Plan together under the parent organization, Point32Health — and on what’s ahead in 2023, by:

  • Reading our updated FAQ that provides information on what is coming in 2023 where you can learn about our more unified product portfolio, behavioral health model, new pharmacy benefit manager, our aligned approach for Medical Benefit Drugs utilization management and more.
  • Signing up for one of our provider webinars aimed at helping you and your staff stay apprised of the latest news and updates.

Click here to learn more.

Tufts Medicare Preferred

2022 Formulary Change Notice (Tufts Medicare Preferred HMO Individual & Senior Care Options (SCO))

The coverage listed attached is effective for our Tufts Medicare Preferred HMO Individual and Tufts Health Plan SCO plans. For changes affecting the Tufts Health Plan Medicare Preferred Employer Group, Tufts Health Plan Medicare Preferred PDP and Tufts Health Unify, please reference the applicable plan’s formulary. To view the complete notification, click here.

Coming in 2023: Tufts Medicare Preferred Access (PPO)

Beginning on Jan. 1, 2023, Tufts Health Plan will offer a Medicare Advantage PPO product, Tufts Medicare Preferred Access (PPO), to individuals in Massachusetts. With the addition of a PPO option alongside Tufts Medicare Preferred HMO, Medicare eligible individuals will have more choice when selecting a product to meet their unique needs. For additional information and to view the entire notification, click here.

Tufts Health Plan SCO Annual Training

Tufts Health Plan SCO is required to provide annual training to participating providers. To facilitate your completion of this required training, Tufts Health Plan has developed the following online educational materials:

You can find the link to the attestation at the bottom of page 41 of the slide deck.

Tufts Health Plan asks that you complete the online training and attestation by January 30, 2023. 

If you have any questions about the training or how to access it, please contact Tufts Provider Services at 800.279.9022. Thank you in advance for your participation.

Behavioral Health Referral and Authorization Updates

Tufts Medicare Preferred HMO and Senior Care Options, we’re making updates to referral and authorization requirements related to the following behavioral health (BH) services: Repetitive Transcranial Magnetic Stimulation, Psychological/Neuropsychological Testing and Assessment, BH Outpatient Psychotherapy, and Intensive Outpatient Programs. For additional information and to view the entire notification, click here.

Tufts Health Public Plan

Behavioral Health Screening Tools and Codes Update (Tufts Health Together)

Effective Jan. 1, 2023 and per MassHealth All Provider Bulletin 348, providers will be required to use a new service code (96127) when billing for developmental and behavioral health screening. Providers will continue to be paid at the same rate. For additional information and to view the entire notification, click here.

Tufts Health Plan

Modifier Reminder: Reporting a Separate and Distinct Procedural Service

Modifier 59 should only be appended/reported for a distinct procedural service that is not normally reported together with the primary procedure, such as: Different session or patient encounter; Different procedure or surgery; Different anatomical site or organ system; Separate incision or excision; Separate injury. For additional information and to view the entire notification, click here.


January is Cervical Health Awareness Month

  • Greater than 14,000 U.S women are diagnosed with invasive cervical cancer every year
    • Greater than 4000 cervical cancer related deaths/year in the U.S.
  • Cervical cancer can be prevented with routine screening and on time HPV vaccination
    • On Time HPV Vaccination= 2 doses before 13th birthday
  • 99.7% of cervical cancers have HPV detected
  • Early cervical cancer is typically asymptomatic
    • On time, routine screening is critical
      • More than 50% of patients with cervical cancer were not screened adequately

Text Campaign: January 2023

  • BILHPN will be conducting a Cervical Cancer Screening Texting Campaign in January 2023 for all patients ages 21-64 who are due.
  • 2022 text verbiage (This may be updated for 2023):

[Practice Name] @ Beth Israel Lahey Health: One important component of primary care is preventive care. Scheduling a pap smear – the screening test for cervical cancer – with your primary care provider (PCP) or gynecologist can help find cervical cancer early when it’s easier to treat. To update our records or to schedule a visit with your PCP, please call [PRACTICE NAME]

Current Routine Screening Guidelines: ACS (2020), USPTF (2018), ACOG (2016)


  1. Screening for cervical cancer in resource-rich settings
  2. Invasive cervical cancer: Epidemiology, risk factors, clinical manifestations, and diagnosis


Please click here to take a moment to read the Provider Spotlights!

If you would like to be featured on the PHO website, please reach out to Alycia Messelaar at or 978-236-1784.

Virtual Networking videos from NEPHO providers can be found at

Please reach out to Alycia Messelaar at if you are interested in being featured in a Virtual Networking video. 


Practice Administrators and Office Managers,

Many physician practices have created social media pages to promote their services and share information with their patients. Northeast PHO would like to know how we can help our providers share information with each other. If you have not already responded, please take a moment to complete this brief survey to help determine how we can best help you.

Click here to take the survey.

Click here for the PDF version of the updated PHO Directory as of December 2022. For your convenience click here for the separate Specialists Only PDF directory to refer to as needed.

Please share this directory with your office by printing or showing them how to visit us online for an easy to use directory search tool.

Note: Primary care providers (PCPs) in the BILH Performance Network no longer need to submit an administrative referral to refer Blue Cross Blue Shield of MA, Harvard Pilgrim Health Care, or Tufts Health Plan members to a specialist in the BILH Performance Network. Please reach out to Alycia Messelaar,, regarding questions pertaining to providers within the BILHPN Network. 

As a reminder, it is important to use the NEPHO Physician Directory when referring to a specialty physician. 

Here at the PHO, we completely understand how overwhelming it can be to stay on top of all the email communications that are being sent on a day-to-day basis. In an effort to keep you well informed, below you will find a highlight of key memos that have been sent out over the last month – JUST in case you missed it!

  • Monthly BILH Pharmacy Newsletters
  • Monthly BILHPN BMC WellSense MassHealth ACO Newsletter
  • 2023 Attendance Policy
  • Boston Children’s Hospital: Updated Urgent Access Guide and BCH Pedi Environmental Health Grand Round sessions for Jan. and Feb.
  • BILHPN TMP Drop in Session with NEPHO – January 5th at noon
  • 2022 Affiliation Mailing
  • December 2022 Office Manager meeting slide deck
  • Social Media Survey (Office Managers) – Click here to complete

Please reach out to for a specific communication that you are unable to find.


2023 Evening Clinics

The Quality Team is in the process of planning a series of evening clinics for patients with diabetes and hypertension. Our goal is help provide care for patients who may not be able see providers during normal business hours. Some of the clinics will offer retinal scans for patients with diabetes who are overdue for eye exams. The A1C and Blood pressure checks are free for all patients.

Please see below for the dates, times and locations of the proposed clinics. More information will follow as the clinics are confirmed. 

2/6/23   5pm-6:30pm        BP/A1C/Retinal Scanner   5 Federal St. Danvers

3/6/23   5pm-6:30pm        BP/A1C   AGH – BILHPC 4th Floor

4/3/23   5pm-6:30pm        BP/A1C/Retinal Scanner   5 Federal St. Danvers

5/1/23   5pm-6:30pm        BP/A1C   AGH – BILHPC 4th Floor

6/5/23   5pm-6:30pm        BP/A1C/Retinal Scanner   5 Federal St. Danvers

After June the Quality Team will evaluate the clinics and determine the schedule for the remainder of 2023.

If you have any questions about the proposed clinics, please reach out to Ali Wiklund, NP at or Laureen Viel at


The Northeast PHO recognizes the complexity of navigating referral management and how patient conversations can be difficult. The Referral Management Department has created a resource to help guide you through some of the common challenging conversations with patients from both the provider and staff perspectives.  Click here to view and print a conversational tool to share with practice staff.

As a reminder, the Beth Israel Lahey Health logo is not always an indication that a provider is in the Northeast PHO (NEPHO) or Beth Israel Lahey Health Performance Network (BILHPN). Please rely on the following two provider directories to determine whether or not a provider is within NEPHO or BILHPN:
NEPHO is here to help you with referral needs. Please contact Ann Cabral with questions or concerns, or 978-236-1758.


OPTUM NEWSLETTERDecember – Chronic obstructive pulmonary
disease (COPD)

NEPHO is working to close down 2022 and preparing for 2023. There are a few keys areas to make sure practices and providers are focusing on to the start of January 2023. The two priority areas include the following:

Hierarchical condition categories (HCCs) Coding Capture: All chronic conditions captured in 2022 will reset as of January 1, 2023.

  • Chronic conditions should be coded and captured on an ongoing basis to support quality patient care.
    • Example: A patient with Diastolic congestive heart failure and hypertension should be coded as follows annually: Chronic CHF: I50.32 and hypertension with CHF: I11.0.
  • Treatment and care for the condition needs to be supported by documentation and diagnosis capture.
    • Example: Mr. Jones is taking Lisinopril and following up with Cardiology to manage his CHF I150.32.
  • All diagnoses that receive care and management during a patient encounter should be captured.
    • Example: Mr. Jones depression has been stable taking Celexa and seeing his counselor monthly. Recurrent depression would be coded as patient still on medication treatment: F33.81.
  • Conditions that are no longer active and/or not being treated should not be captured/reported. This should include problem list diagnoses that have be resolved.
    • Example: Mr. Jones Type II diabetes has resolved as he has been following a low salt diet and exercise routine. Diabetes Type II E11.9 should be updated on the problem list as “resolved” as it is no longer an active problem.
  • Capture “history of” and “status” of conditions when there is an impact on patient current care or treatment.
    • Example: Mr. Jones has history of prostate cancer. He has been cancer free for 12 years. History of prostate cancer will be captured as: Z85.46.

Diagnoses captured need to be supported by documentation. A diagnosis does not have to be in the assessment portion of the note. Providing a status update is sufficient to capture the diagnosis.

  • Example: Mr. Jones Type I diabetes is stable and is managed by Endocrinology. Type I diabetes E10.9 can be coded as documentation supports diagnosis capture.

Please reach out to Jessica Bryan, with general coding questions and help with capturing HCC codes for 2023. 


Beth Israel Lahey Health Primary and Specialty Care, Beverly – 30 Tozer Road Suite 203

  • Dr. Deborah Shih is one of the best PCPs I have ever had. She listens and has a genuine concern about her patients.
  • I was very pleased with the care I received with Dr. David Driscoll.  From the front desk to the medical assistant to Dr. Driscoll my care was exceptional!

Beth Israel Lahey Health Primary Care, Beverly – 30 Tozer Road

  • Excellent first visit with Dr. Spencer Amesbury. I am thrilled to have found him.

Beth Israel Lahey Health Primary Care, Beverly – 100 Cummings Center 

  • Dr. Pierre Ezzi is very professional, knowledgeable & courteous!

Beth Israel Lahey Health Primary Care, Beverly – 900 Cummings Center 

  • Another outstanding visit with Dr. Daniel McCullough and his staff!
  • Dr. Andrew Lenhardt and Nurse June are spectacular and wonderful!

Beth Israel Lahey Health Primary Care, Danvers – 5 Federal Street 

  • Dr. Brent Fryling explained everything clearly and understanding.  Excellent appointment, good information.

Beth Israel Lahey Health Primary Care, Danvers – 480 Maple Street Suite 204

  • I love Dr. Kristina Jackson! She is so thorough and truly cares about her patients. I have recommended Dr. Jackson to a friend of mine.

Beth Israel Lahey Health Primary Care, Gloucester – 298 Washington Street 1st Floor

  • I have had only good experiences.  I have gone to Dr. Amy Esdale for many years.  Always prompt – patient, and listens to my thoughts on my problem – never seems rushed, and takes any of my problems very seriously – the staff, especially Teresa are very compassionate, and friendly.
  • Dr. Kathryn Hollett was kind and gracious

Beth Israel Lahey Health Primary Care, Gloucester – 298 Washington Street 4th Floor 

  • Dr. Victor Carabba is a very knowledgeable, caring physician. He ALWAYS takes the time to explain things to you and makes you feel comfortable.
  • Dr. Karen Damico is kind, caring, and very knowledgeable and her staff is extremely helpful and friendly!

Beth Israel Lahey Health Primary Care, Hamilton – 15 Railroad Avenue 

  • Dr. Laurence Gordon is a kind and caring physician. Attentive, active listener, does not rush the appointment. Gives me all the time needed.

Beth Israel Lahey Health Primary Care, Manchester – 195 School Street 

  • Everything was great from the time I checked in at the front desk to the time I left. I am sorry I did not get the names of the people at the front desk because they were excellent as was Bob, Dr. Jana Oettinger, and Ivy!
  • Excellent professional thoughtful care from Dr. Matthew Plosker. Very satisfied and appreciative of my caregiver.

Blackburn Primary Care, Gloucester – 1 Blackburn Drive

  • Dr. Jay Isaac and Michaela take GREAT care of me!  Thank You!
  • Dr. Jay Isaac always listens to me and never rushes me.  He is one of the best Physicians I have ever had!

Brian Orr Pediatrics, Gloucester – 1 Blackburn Drive

  • The staff is always helpful and friendly. Dr. Brian Orr is a caring and dedicated pediatrician. We have appreciated him and his entire staff for 20 years.

EMTAR, South Hamilton – 205 Willow Street

  • Long time patient of Dr. Michael Edwards. Always a very positive experience.  He is the best.

Essex County Primary Care, South Hamilton – 42 Asbury Street 

  • Dr. Nicholas Avgerinos is an outstanding physician.  He listens carefully, treats me with respect and explains courses of action fully & clearly.  I have already recommended him to several friends and acquaintances!

Garden City Pediatrics, Beverly – 83 Herrick Street 

  • Dr. Sheryl Silva – I would never bring my child anywhere other than garden city pediatrics, they’re a wonderful team!
  • Dr. Ian Sklaver always takes time with both of my teens.  He really listens to me and them!

Leonard Horowitz, M.D., Danvers – 7 Federal Street

  • Dr. Leonard Horowitz and the staff at his office are absolutely the best!

North Shore Pediatrics, Danvers – 480 Maple Street 

  • We love NSP.  Dr. David Danis has been amazing and made us feel so comfortable/heard.  The nurses and desk staff are wonderful as well.
  • Dr. Lance Goodman – We LOVE North Shore Pediatrics! The entire practice has felt like family to us since both of our kids were babies. We could not imagine them receiving care at any other location!

Thomas Pearce, M.D., Gloucester – 279 East Main Street

  • Dr. Thomas Pearce has been my doctor for over twenty years.  He has always been there for me when I needed him.  I trust and rely on him to take care of me.

Thompson Medical Associates, Gloucester – 9 F Dr. Osman Babson Road 

  • Dr. Candace Thompson and physician assistant very thorough and explains diagnosis and my condition clearly.  They take their time and answer all my questions.  Office staff is very professional.


The Northeast PHO recognizes colleagues who provide a positive experience for our patients, help us keep care local, meet our quality targets and support their colleagues.
This month’s winners are:

Julia Flynn, BILH Primary Care Danvers, was recognized for her efforts to keep specialty care in the Northeast PHO network.

Lisa Bowen, BILH Primary Care/Specialty Care Beverly Medical Associates, was recognized for her efforts to keep specialty care in the Northeast PHO network.

Left to Right: Sheryl Berg MA II, Yinnellis Moya, CA, Julia Flynn medical receptionist, Tracy Pelletier, Practice Manager, North Shore Primary Care

From Left to Right: Dr. Deborah Shih, Lisa Bowen and Kerry Sakelakos at Beverly Medical Associates 

Please let us know if you would like to nominate a team member in your practice or another practice for the recognition program. 

We will deliver gift cards to the winners each month, and they will be announced here in the newsletter. Please be sure to look for the new winners in next month’s issue!