NEWS FROM NEPHO – March 2020 Edition


Bart Blaeser, DMD
Salem Peabody Oral Surgery
6 Essex Center Drive, Suite 112A
Peabody, MA 01960
(P) 978-531-1450 (F) 978-531-9984

Poonam Doshi, MD
Specialized Pediatric Eye Care
77 Herrick Street, Suite 102
Beverly, MA 01915
(978)338-4321 (978)927-1010

Laura Harvey, MD
Beverly Anesthesia Associates

480 Maple Street, Suite C233 A
Danvers, MA 01923
(978)304-8690 (978)304-8697

Siew Teoh, MD
Beverly Radiological Associates
85 Herrick Street
Beverly, MA 01915
(978)922-3000 (978)927-3534


  • Elizabeth Emberley, MD of Essex County OB/GYN has resigned effective 5/17/2020
  • Steven LaRosa, MD of Lahey Infectious Disease, Beverly has resigned effective 4/27/2020
  • Jeffrey Polansky, MD of Sports Medicine North has retired effective 3/1/2020


Click here
for meeting flyer
Guest Speaker: Mary McCaffrey, MD
Date: April 15, 2020 @12:00 p.m.
This meeting will be rescheduled for later in 2020
Place: TBD
RSVP: Judith.O’ or 978-236-1739

Date: April 29, 2020 @7:30 a.m.
Place: 500 Cummings Center, Suite 6500
Wingaersheek  Conference Room – Beverly, MA 01915
RSVP: or 978-236-1784

Please check the meeting calendar on our website to get the latest meeting status, notification of new TeleHealth conference calls, Specialty Specific meetings, and POD/IPA meetings.   Due to the hospital COVID-19 directive regarding social distancing for meetings we will be providing conference call information and links for upcoming meetings on the meeting invites and via email reminders.   A COVID-19 tab is provided on our site which we hope you will visit to read the latest updates and the various helpful links regarding the coronavirus.
Support our frontline medical colleagues by staying home and staying safe!


Headspace is currently free for providers
just using their
NPI number. 



Please reach out to Alycia Messelaar,  to keep NEPHO informed of changes in practice schedules due to COVID-19  (office closures, limited office hours, scope of appointment, telehealth use, phone line to reach staff, etc.) or if you have questions about other practice schedules.

The Northeast PHO has successfully implemented Telehealth
services in four practices. Telehealth services are becoming a focus
point in Massachusetts and nationwide, especially with the current COVID-19 news. This communication is to offer our support to help establish a fully operational Telehealth program within your practice.

Please reach out to Shawn Bromley directly, or 978-236-1704 if you are interested in learning more about implementing a Telehealth program within your practice. A NEPHO Telehealth Team member will work with you directly to ensure a solid program is developed and implemented.

The NEPHO Telehealth Team looks forward to working with you on this fast moving telehealth program initiative.

Thank you,

NEPHO Telehealth Committee
Shawn Bromley
Alycia Messelaar
Janelle Jensen
Stephanie Cunningham
Judith O’Leary


Harvard Pilgrim Health Care

2020–2021 Tiering for GIC Products

Annually, HPHC provides practice/provider tier classifications for Harvard Pilgrim Health Care and the Group Insurance Commission’s (GIC’s) Primary Choice HMO (tiered limited network plan) and Independence Plan POS (tiered full network plan) products. Please note that for the 2020-2021 plan year, tiers are not changing and the following tier classification will continue to apply.

We recommend that you share your tier classification with all NEPHO practice locations. Member copayments vary by tier, and product name and copayment information is listed on the member ID card.

Tier assignments are based on quality and cost performance, as measured by health-status-adjusted total medical expenses and relative prices. Harvard Pilgrim utilized measures endorsed in the Standard Quality Measurement Set (SQMS), introduced by the Massachusetts Statewide Quality Advisory Committee, to provide a standardized quality measurement system. If applicable quality measures were unavailable, tiers were based solely on health-status-adjusted total medical expenses or relative prices, or both.

If you have any further questions regarding Harvard Pilgrim’s tiering methodology or general questions, you may send an email to or call 978-236-1784.

Commonwealth Care Alliance

Commonwealth Care Alliance has partnered with NEHEN to provide real-time member eligibility verification beginning on March 30, 2020.

This notification describes the services offered by NEHEN and how to join their network.  This value added service can be utilized by providers who are currently enrolled with NEHEN to obtain eligibility confirmation faster.

This new service is now offered to CCA providers to verify eligibility. Providers should verify eligibility utilizing one of the following options available:

  1. Using the NEHEN Provider Portal
  2. Logging into the EZ NET Online Claims Web Portal
  3. Using the MassHealth Provider Online Service Center

 New England Healthcare Exchange Network (NEHEN)

NEHEN is a consortium of regional payers and providers who have designed and implemented a secure and  innovative health information exchange for reducing administrative costs and improving the quality, safety, and efficiency of patient care. NEHEN technology has changed the way administrative, clinical, exchange, and ePrescribing processes are performed in member organizations. NEHEN offers its members tools to address the challenges faced by the healthcare industry.

Eligibility Verification Services

The following real-time eligibility verification services are now available:

  • Web Portal, Batch or integrated real-time transactions
    • Batch file 270/271 transactions
      • Validate all of our members within the batch at one time
  • Single individual searches
    • Validate eligibility for a single member
  • Discovery Feature searches
    • The discovery features searches to locate the proper payer information for a member; NEHEN can check eligibility against 13 participating health plans simultaneously!
  • System available 24/7 days access
    • System is available 24 hours a day 7 days a week
  • Advanced Activities Reporting
    • Reporting and analytics related to transactions conducted

The discovery features searches to locate the proper payer information for a member; NEHEN can check eligibility against 13 participating health plans simultaneously!

  •  System available 24/7 days access
    • System is available 24 hours a day 7 days a week
  •  Advanced Activities Reporting
    • Reporting and analytics related to transactions conducted

How to become a NEHEN member

For NEHEN membership information, please email the NEHEN Program Manager at or call them directly at 781-907-7210.

Thank you for your continued support and the quality care you provide to CCA members.
If you have any questions, please contact CCA Provider Services at 866-610-2273.

CMS – Medicare

Add-On Code Edits – 2020 (Update)

Change report for add-on edit changes and complete file of add-on code edits update for 4/1/20 have been added to the website. To view the notification, click here and locate the file in the downloads section.

Blue Cross Blue Shield of Massachusetts

Working with Provider’s Billing Agency (Tips for Providers)

If providers contract with a billing agency to handle certain insurance processes, BCBSMA has some tips for providers. To view the complete notification, click here .


Primary Care Quality Meeting – Practice/NEPHO Partnership

In the month of March, the PHO Quality Team held its first ever Quality Meeting for Primary Care practices. The original plan was to hold meetings on 3 different dates at 3 different sites, Addison Gilbert Hospital, the Cummings Center in Beverly and LOCD in Danvers.  Office Managers and their staff involved in the Quality outreach were invited to attend one of the sessions.  Due to the situation with the coronavirus, the Beverly and Danvers meetings were held remotely as a safety precaution.

The corner stone of our Quality strategy is our partnership with the PCP Practices. The meetings focused on ways we can work together to reach quality goals and ensure good care for all of our patients. Topics covered included:

  • The Practice-PHO Partnership
  • Quality Work Time Line for the Year
  • What the PHO Quality Team will do to support Practices in their Quality work
  • A preview of the Quality Reports for 2020
  • Best Practice Tips including a special presentation by Tracy Pelletier from Lahey Primary Care Danvers

There were a number of handouts available for colleagues to bring back to their Practices:

  • Care Needed Checklist
  • Quality Team Contacts
  • 2020 Ambulatory Quality Measures
  • Colon Cancer Screening Posters

The PHO Team is planning to hold another Quality Meeting in August that will focus on the year end Quality strategy as well as other topics of interest to our Practice colleagues.

If you were unable to attend one of our sessions in March and would like copies of the hand outs and/or the slides from the meeting presentation please email Jennifer Andersen at or Laureen Viel at


New Over-the-Counter Meds Available

The FDA recently approved the following meds for over-the-counter (OTC) non-prescription availability:

  1. Relion Novolin Insulin PENS (Regular, NPH and 70/30) are now available  OTC at Walmart and Sam’s Club Pharmacies in addition to vials. PEN    needles must be purchased separately and are also available without a prescription. Cash cost is about $25 for 10ml vials, $43 for 3 x 5mls PENS and $15 for #50 PEN needles.
  2. Voltaren Arthritis Pain (diclofenac sodium topical gel, 1%) Over-the-Counter for the temporary relief of arthritis pain
  3. Pataday Twice Daily Relief (olopatadine HCl ophthalmic solution/drops, 0.1%) Over-the-Counter for the temporary relief of itchy and red eyes due to pollen, ragweed, grass, animal hair or dander
  4. Pataday Once Daily Relief (olopatadine HCl ophthalmic solution/drops, 0.2%) Over-the-Counter for the temporary relief of itchy eyes due to pollen, ragweed, grass, animal hair or dander, for nonprescription use.

For questions or more information contact Carol Freedman, NEPHO Pharmacy Manager 978 236 1774 OR


OPTUM Newsletter – March 2020 Focus: Nutrition

In an effort to keep all NEPHO providers up to date with COVID-19 news we are providing detail to the new ICD-10 CM codes that have been released by the CDC. These new codes will support tracking of the virus and support medical management of virus containment. Important links are provided to keep all providers current with COVID-19 updates. In addition I have attached a detailed summary of current Telehealth coding and billing information to help support reimbursement for Telehealth services.

Please reach out to me directly with questions regarding these new coding and billing updates – all providers need to check in with their system vendors and billing/coding vendors to ensure updates have been made to systems and billing and coding is current.

Thank you,
Shawn M.


The CDC released the official diagnosis coding guidance for encounters and deaths related to the 2019 novel coronavirus (COVID-19), effective February 20, 2020.

COVID-19 infections cause a range of illness severity, from no symptoms to severe illness and potentially death. Coronavirus symptoms include fever, cough, and shortness of breath and may appear between two and 14 days after exposure.

This guidance is intended to be used in conjunction with current ICD-10-CM classifications and will be updated to reflect new clinical information as it becomes available. The codes provided are intended to give information on the coding of encounters related to COVID-19; other codes for conditions unrelated to coronavirus might be required to fully code scenarios in accordance with ICD-10-CM Official Guidelines for Coding and Reporting.

For confirmed cases of pneumonia due to COVID-19, use codes:

  •  J12.89, Other viral pneumonia, and
  •  B97.29, Other coronavirus as the cause of diseases classified elsewhere

For confirmed cases of acute bronchitis due to COVID-19, use codes:

  •  J20.8, Acute bronchitis due to other specified organisms, and
  •  B97.29, Other coronavirus as the cause of diseases classified elsewhere

For bronchitis not otherwise specified (NOS) due to COVID-19, use codes:

  • J40, Bronchitis, not specified as acute or chronic, along with code
  • B97.29, other coronavirus as the cause of diseases classified elsewhere

For lower respiratory infections, NOS, or an acute respiratory infection, NOS,
with associated documented COVID-19, assign codes:

  • J22, Unspecified acute lower respiratory infection, with code
  • B97.29, Other coronavirus as the cause of diseases classified elsewhere

For respiratory infections, NOS, with associated documented COVID-19, use codes:

  • J98.8, Other specified respiratory disorders, with
  • B97.29, Other coronavirus as the cause of diseases classified elsewhere

For confirmed acute respiratory distress syndrome (ARDS) due to COVID-19, assign codes:

  • J80, Acute respiratory distress syndrome, and
  • B97.29, Other coronavirus as the cause of diseases classified elsewhere

To code a concern about COVID-19 exposure that was ruled out after evaluation, use code:

  • Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out

To code actual COVID-19 exposure with a confirmed coronavirus case, assign code:

  • Z20.828, Contact with and (suspected) exposure to other viral communicable diseases

For patients presenting with symptoms where a definitive coronavirus diagnosis is not established,
assign the appropriate codes for each presenting symptom, such as:

  • R05, Cough
  • R06.02, Shortness of breath
  • R50.9, Fever, unspecified

Diagnosis code B34.2, Coronavirus infection, unspecified, would not generally be appropriate for COVID-19 because confirmed cases have universally been respiratory in nature, so the site would not be unspecified.
According to the new guidelines, do not assign code B97.29 if the provider documents “suspected,” “possible,” or “probable” COVID-19. Instead, assign codes explaining the reason for the encounter (such as fever, or Z20.828).


As of today, Massachusetts Health Quality Partners (MHQP) plans to field their annual patient experience survey which will be mailed to patients starting the end of April.  Statewide adult primary care patients as well as pediatric primary care patients will be surveyed thru July.  The survey results  will be posted on their website  in the winter of 2021.  This survey reports on various domains such as provider communication, knowledge of patient and integration of care as well as patient access and other office related patient experiences.  If you have any questions, please contact Stephanie Cunningham at or Liz Isaac at  for more information or support.  Be well.


Blackburn Primary Care – 1 Blackburn Drive

  • All my experiences with Jay Isaac are excellent! He takes time to teach me how I can improve
    my health if one of my tests are off.  He is an excellent listener and professional doctor!

Cape Ann Medical Center – 1 Blackburn Drive

  • I have all the faith in James Maguire.

Cape Ann Pediatrics – 298 Washington Street

  • Jeffrey Stockman is the best. Thanks to everyone at Cape Ann PEDI!

Danvers Family Doctors – 140 Commonwealth Avenue, Suite 202

  • It is always a good experience when I have a visit with Subroto Bhattacharya.

Garden City Pediatrics – 83 Herrick Street

  • We love Suzanne Graves! Wouldn’t trust anyone else with my sons!
  • Jacob Kriteman and his staff are friendly, the facilities are clean and they have knowledgeable
    doctors and nurses. Keep up the good work GCP!

Lahey Primary Care, Beverly – 30 Tozer Road

  • Gail Ellis, her nurses and the staff have always given exemplary, caring, wonderful care
    and concern for me.

Lahey Primary Care, Danvers – 480 Maple Street

  • I was referred to Kristina Jackson by a family member and I am very happy with my choice. I
    have also referred this care provider to others.
  • Galina Feldman is great, I feel like I can talk to her about anything, she’s an asset to this practice.

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

  • This was my first visit with Yuliya Mandel and she made me very comfortable and was a very
    good listener. I look forward to seeing her more in the future as she was one of the best doctors
    I’ve seen in a while.
  • Victor Carabba and staff are excellent. They go out of their way and I feel they really care about you.

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

  • Kathryn Hollett has always provided excellent care – her staff is very helpful.

Lahey Primary Care, Hamilton – 15 Railroad Avenue

  • I love Hugh Taylor and his staff. Always feel well taken care of!

Lahey Primary Care, Manchester – 192 School Street

  • I’ve been with the practice since an original provider ( Dr. Bazylewicz) started. Thought I might
    change after Dr. La Barge retired.  Then I met Dr.  Matthew Plosker, so I’ve decided to stay!

Spencer Amesbury, MD (Mindful Medicine) – 900 Cummings Center, Suite 218U

  • Spencer Amesbury and staff have ALWAYS given me excellent care, and are VERY kind and
    patient. I trust them completely.

North Shore Pediatrics – 480 Maple Street, Danvers

  • We love Maureen Mathews! She is so respectful of my children and spend a lot of time
    explaining everything.
  • David Danis is always so thorough his nurses are so kind and front end staff is great.

Dr. Brian Orr Pediatrics – 1 Blackburn Drive

  • Brian Orr is the best! He is very thorough and explains everything.

Patton Park Medical – 42 Asbury Street

  • I am treated with respect always by my doctor, Michael Edwards and he is a wonderful listener.

Thomas Pearce, MD – 279 E Main Street

  • I always leave Thomas Pearce’s office feeling fully informed and properly cared for.


The Northeast PHO recognizes colleagues who provide a positive experience for our patients, help us keep care local and meet our quality targets.

This month’s winners are:

Liz Blatchford, Cape Ann Medical Center, was recognized for the patient experience comment “Liz is great to consult on appointments and any paperwork that I need to get done”

Helena Dos Santos, Coastal Orthopedic Associates, was recognized for assisting Referral Management in re-directing patients back in PHO

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!