News from NEPHO – OCTOBER 2023 Edition


  • Grace Jang Suk, MD of Beth Israel Lahey Health Primary Care, Beverly 30 Tozer Road Beverly, MA 01915 Phone: 978-927-7727 Fax: 978-927-4598
  • Eric Grover, MD of North Shore Neurology & EMG, 30 New Crossing Rd Suite 207, Reading, MA 01867 Phone: 978-922-2226 Fax: 781-779-8385


  • Alyssa Handler, MD of Beth Israel Lahey Health Primary Care and Specialty Care Beverly Medical Associates has closed her panel, except to existing patients
  • Karen Damico, DO of Beth Israel Lahey Health Primary Care, Gloucester has closed her panel, except to existing patients
  • Margaret Legner, MD of Beth Israel Lahey Health Primary Care, Danvers has closed her panel, except to existing patients
  • Erica Bial, MD of Sports Medicine North has termed, effective 10/5/2023
  • Subroto Bhattacharya, MD of Danvers Family Doctors will be terming, effective 1/1/2024
  • Nicholas Avgerinos, MD of Essex County Primary Care will be terming, effective 1/1/2024


NP/PA Meeting
Kim Willis, NP-C, Nurse Patient Navigator
Wednesday, November 29, @Noon
Breast Health
Location: Teams Meeting

New Physician Orientation Meeting
Thursday, November 9th @ 7:30 am
Teams Meeting

Town Hall Meetings for Providers and Office Managers
Wednesday, December 13 @ 7am (click here for link)
Wednesday, December 13 @ noon (click here for link)
Zoom Meeting

Office Managers:  The Office Manager Meeting on December 13th has been canceled and we encourage you to attend the Town Hall for updates about changes in 2024.

Indian Medical Associates of New England (IMANE) Gala

Dr. Deepa Jhaveri, Northeast PHO member and IMANE President, along with the team at IMANE would like to invite you to the annual Gala on Saturday, December 2, 2023 at the Four Points Sheraton in Wakefield, MA. Please click here for more information.

For questions, please email


Dr. Daniel McCullough has been selected as inaugural Family Medicine Clerkship Director for the new academic collaboration between UMASS-Chan Medical School, Lahey Hospital & Medical Center (LHMC), and Beth Israel Lahey Health Primary Care (BILHPC).  

Dr. McCullough has a long and impressive history of both clinical leadership and medical education. Notably, he has served as faculty preceptor at multiple residency programs including at Maine Medical Center and Beverly Hospital. He has also continued to be involved in medical student education for Boston University since 2000, where he has received many teaching awards for his efforts. Dr. McCullough also serves on the BILH Board of Trustees and as Regional Medical Director for BILHPC, where he has garnered the reputation of consummate and passionate ambassador for all matters primary care, family medicine, and education.

In his new role as Family Medicine Clerkship Director, Dr. McCullough will lead and mobilize medical students from UMass Chan as they enter their family medicine “rotation” at BILHPC sites, precepted by our very own community based primary care physicians! And the timing couldn’t be more ripe; never in the history of health care has there been a more important time to focus on a pipeline of future clinicians into primary care.

Please join us in congratulating Dan on this very exciting new role, and thank you for all of those who will be academic preceptors in the coming years as part of this new program. Learn more about the UMASS-Chan Medical School partnership with LHMC and hear from Dr. McCullough in this video.


North Shore Pain Management is excited to announce they have moved to their new Beverly location at 77 Herrick Street, Suite 201. They are thrilled to offer comprehensive pain management in a bright and modern space. 

Their new location offers patients 2 in-office procedure suites, in addition to 6 exam rooms and clinical exam space for physicians and advanced practice providers. 


We are excited to share that the new BILHPN Provider Directory is live on You can access the directory from the front page of the website, or under the “Provider Resource” tab at the top of the page.  
Please share this news with anyone you feel would benefit from the tool. 


For the second time this year, the Drug Enforcement Administration is extending telehealth prescription options as the agency continues to weigh how and when clinicians can provide drugs virtually. 

For more information, please click here.


There is one texting campaign scheduled for November.

Open Risk:

[Practice Name] @Beth Israel Lahey Health: Your health is important to us. If you have not yet scheduled a visit with your primary care provider’s office, please call [Practice Name] at [Practice Phone]. Regular care is vital to maintaining chronic conditions. To stop receiving messages, reply with ‘STOP’

If you have any questions regarding the BILHPN texting campaigns please contact Laureen Viel at


Blue Cross Blue Shield

Reminder: Providers Need to Submit Requests Via Authorization Manager

As a reminder, all providers are required to submit initial authorization requests and inquiries electronically through Authorization Manager rather than by phone or fax as of June 1, 2023 for the commercial (HMO, PPO) and Federal Employee Program (FEP) members. Despite the required use of the portal, BCBSMA has still been receiving some requests via phone and fax. This is a reminder that providers must submit using Authorization Manager in order for BCBSMA to process the request. BCBSMA does not accept any other methods of submission. To view the complete notification, click here.

Policy 034 Medical Benefit Prior Authorization Medication

BCBSMA has posted an updated Policy 034 Medical Benefit Prior Authorization Medication List. To view the complete list, click here.

Reducing Cost Barriers to Improve Access to Mental Health Care

Effective immediately, BCBSMA is waiving member cost share for services billed with the attached codes. To view the complete notification, click here.

Medical Policy Announcements

This document announces new medical policy changes that take effect Dec. 1, 2023. To view the list, click here.

Pharmacy Medical Policy Update: Drugs for Weight Loss (572)

The policy has been updated as follows: Updated to add new age update for Wegovy and to require additional documentation and updated significant weight loss for Wegovy and the length of approvals were also updated and updated IC to align with 118E MGL § 51A. To view the complete policy, click here.

Harvard Pilgrim Health Care/Point 32 Health

Reminders and Update: Billing for PrEP and HIV Services (Harvard Pilgrim Health Care Commercial, Tufts Health Direct, Tufts Health Plan Commercial)

Prescribing of HIV PrEP medication, as well as ongoing follow-up and monitoring and other related services, are considered preventive services and are required under the Patient Protection and Affordable Care Act to be covered with no cost sharing responsibility for the member when rendered by an in-network provider. When submitting claims for these services, it’s important to bill in accordance with the Harvard Pilgrim Patient Protection and Affordable Care Act (Federal Health Care Reform) policy and Tufts Health Plan Preventive Services Payment Policy to ensure that no member cost sharing is inappropriately applied. To view the complete notification, click here.

Medical Necessity Guidelines: Cardiovascular Disease Risk Tests

Harvard Pilgrim Health Care has updated the Medical Necessity Guidelines as follows: Coverage guideline created to outline medical necessity for cardiovascular disease risk tests, effective July 7, 2023. For additional information and to view the notification, click here.


Seasonal Flu Vaccine Pricing for 2023–2024 Season

Part B payment allowance limits for seasonal influenza (flu) vaccines (that is, the vaccine product) are 95% of the Average Wholesale Price (AWP). In hospital outpatient departments, payment is based on reasonable cost. Part B deductible and coinsurance amounts don’t apply for flu vaccine products or their administration. With respect to the vaccine product, all providers and suppliers must accept assignment on the claim. The annual flu vaccine season is August 1–July 31 of the following year. To view the notification, click here.

2023-09-14-OCE: COVID-19: Updated mRNA Vaccines for Patients 6 Months & Older

On September 11, the FDA approved and authorized for emergency use updated Moderna and Pfizer-BioNTech COVID-19 vaccines formulated to more closely target currently circulating variants and provide better protection against serious consequences of COVID-19, including hospitalization and death. These vaccines have been updated to include a monovalent (single) component that corresponds to the Omicron variant XBB.1.5. The CDC recommends everyone 6 months and older get an updated COVID-19 vaccine. Six New CPT Codes Effective September 11, 2023: 90480 – COVID-19 Vaccine Administration, 91318 – COVID-19 Vaccine, 3 mcg/0.2 mL, 91319 – COVID-19 Vaccine, 10 mcg, 91320 – COVID-19 Vaccine, 30 mcg, 91321 – COVID-19 Vaccine, 25 mcg. and 91322 – COVID-19 Vaccine, 50 mcg. For additional information, click here.

MLN Booklet: Evaluation and Management Services Guide

CMS has made significant updates to the language, order and formatting of this product to better meet provider needs and improve understanding. For additional information, click here.

Vaccine Pricing

Get payment allowances and effective dates for the 2023-2-24 season. For additional information, click here.

Tufts Health Plan

Payment Policy Update: Preventive Services

The policy has been updated as follows: Added codes 90678, 90611, 90622, 90380, and 90381 to the “Adult or Pediatric Immunizations section, effective September 15, 2023. To view the complete policy, click here.

Payment Policy Update: Behavioral Health and Substance Use Disorder

The policy has been updated as follows: Added Harvard Pilgrim Health Care inclusion, effective for DOS on or after November 1, 2023. To view the complete policy, click here.

Autism Spectrum Disorder Services Prior Authorization Form

Tufts Health Plans has posted the most current Autism Spectrum Disorder Services Prior Authorization Form. To view the complete form, click here.

Tufts Health Public Plan

MassHealth Billing Reminders (Tufts Health Plan Senior Care Options, Tufts Health Together, Tufts Health Unify)

While MassHealth is working to renew member eligibility, there may be several eligibility updates occurring at this time. In MassHealth All Provider Bulletin 372, MassHealth shared important reminders of billing responsibilities and billing for retroactively reinstated members. For additional information, click here.


November 13th 5pm-6pm via Zoom:

  • We invite all BILH patients and parents to attend this upcoming educational event focused on cancer screening and prevention.
  • Please feel free to print this flyer and hang it in waiting rooms, exam rooms, or hand it out to your patients.
  • Speakers will include:
    • OB/GYNs: discussing the importance of routine cervical cancer screening
    • Ali Wiklund FNP: discussing the importance of on time HPV vaccination, and the catch-up recommendations for HPV vaccination.
    • Patient With Cervical Cancer: will be discussing their patient experience/impact story of being diagnosed with cervical cancer. 

Please click here to view, download and print a flyer.

For more information, contact Ali Wiklund at


Please take a moment to share this newsletter with staff members to ensure they are being kept up-to-date with important information.

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

Virtual Networking videos from NEPHO providers can be found here.

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

Please click here to listen to Healthcare 360, a podcast from Dr. Rob Fields, Chief Clinical Officer at BILH. 

Click here for the PDF version of the updated PHO Directory as of October 2023. 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 at 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 are the 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
  • Monthly Beth Israel Lahey Health Performance Network CDI Newsletter
  • BILHPC’s Core CME Series Offer
  • Boston Children’s Hospital
    • FREE virtual Pediatric Environmental Health (PEH) Grand Rounds “The Environment and Children’s Cancers” Continuing Education Opportunity
    • Advances in Pediatric Healthcare Event
    • BCH October Continuing Education Events

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


  • Health plans with blood pressure (BP) measures in their quality programs require submission of the last ambulatory BP reading found in the chart for the patient in the measurement year.
  • Health plans set a target blood pressure of less than 140 systolic and less than 90 diastolic for patients with hypertension.
  • Here are NEPHO’s current BP measure rates (BCBS HMO):

% of patients with diabetes who have documented BP <140/<90:   78%
% of patients with hypertension who have documented BP <140/<90:  77%

  • Our year-end goal is 85% for each measure above, so each BP that is recorded helps!
  • Please continue to record a 2nd BP for patients who are above 139 systolic and/or above 89 diastolic.
  • Second BPs are helpful to ensure an accurate reading. In addition, health plans allow submission of the best systolic and the best diastolic values from BP readings taken at the same visit. 
  • Patient-provided blood pressure readings from home, either called in to the office or during a telehealth visit, also count.
    • EPIC users, please use .telehealthbp to capture all required documentation.
    • Users of other EMRs, here is a documentation example (with all required documentation) to use when recording patient home BPs:

The patient has taken (his/her) BP (today/earlier date) with a home blood pressure automated digital monitoring device. The patient (verbally/visually/with written text) communicated the BP reading, which has been entered in the Vital Signs or Flowsheets documentation area of this EMR. The BP data has been reviewed via this telephone/telehealth visit.

  • If you see the below prompt on a patient’s chart, it is placed by NEPHO Quality team as a friendly reminder to please record a 2nd BP for that patient.

PHO Alert: please
retake BP if >139.89.

  • If you have patients who would benefit from a BP cuff to record BPs at home, please contact Liz Isaac at Thank you.


The Northeast PHO Referral Department has developed an EPIC user referral pad .dot “smart phrases” in order to help streamline the referral process as well as retain care within the Northeast PHO. These referral pad smart phrases when inserted into patient notes or discharge instructions will print out NEPHO Specialist Names/Addresses/Phone Numbers on the patient AVS (After Visit Summary).

Many practitioners have found these smart phrases to be very useful in conjunction with the paper referral pads. For further education on how to use these smart phrases within EPIC, please reach out to Ann Cabral at

Click here to view local genetic testing sites. Please share this within your practice. As always, please feel free to contact Ann Cabral with questions or concerns regarding this information,


There is one training session still scheduled for 2023. Click on the link below to register.

Arcadia Acuity Training

November 7, 2023, from 12:05 – 1 pm


OPTUM NEWSLETTEROctober- Focus on Cancer

Please click here to view the 2023 Optum webinar schedule.

Congestive Heart Failure is a common cardiac condition that is often missing codes. Updating the patient’s problem list and using the correct ICD-10 codes when billing can increase HCC weight and RAF closure.


  1. Associating diseases is key to increasing HCC
  2. Specifying type/chronicity is equally as important

Example: 70-year-old patient with a past medical history of systolic heart failure, hypertension and CKD stage 4

I13.0: Hypertensive heart and renal disease with congestive heart failure

.331 HCC weight


I13.0, I50.22, N18.4: Hypertensive heart disease with chronic systolic congestive heart failure and stage 4 CKD

.951 HCC weight (.331, .331, .289)

EPIC Providers: EPIC tip

SEARCH: “Hypertensive heart disease with kidney”

SELECT: use click boxes to select highest known specificities of associated disease(s)

Please reach out to Jessica Bryan at with questions or concerns regarding this clinical documentation tip or any other coding guidance.


Stephanie Cunningham and Liz Isaac presented Patient Experience “refresher” training at Essex County OB-GYN’s all staff meeting this month. KUDOS to ECOBGYN for continuing to prioritize improving their patients’ experience of care! Thanks for the opportunity to collaborate with your energetic and fun team.

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

  • Dr. Spencer Amesbury is a very caring, well informed Doctor.
  • This was our first time meeting Dr. Karenjeet Chahal. She was very nice, calm, and friendly.
  • Dr. Gail Ellis is very sharp and meticulous but also always compassionate and careful to listen and explain in as much detail as I want and need.
  • Dr. Neeraj Mahajan is the best!

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

  • Dr. David Driscoll always takes time to listen to you. He never rushes you and takes time to listen to you. Dr. Driscoll should be commended for his care he gives to his patients. I would definitely recommend him to my family or friends.
  • I travel from New Hampshire to Beverly MA to see Dr. Deborah Shih and will continue to do so. Dr. Shih is the absolute best primary care doctor I have EVER known and cares deeply for her patients. Dr. Shih should be recognized in this institution.

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

  • Dr. Pierre Ezzi & his Team continue to impress me with their knowledge & professionalism. My visit was conducted with my care in top of mind.

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

  • Dr. Andrew Lenhardt is the best! He is professional, caring and exceptional, I value being part of his practice
  • As usual, Dr. Daniel McCullough and his staff were SUPER. I feel very lucky to have him as my PCP!

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

  • Dr. Brent Fryling is excellent. He listens to you, takes time with you, and always makes you feel very comfortable about asking questions and discussing how you’re feeling.
  • Dr. Margaret Legner is so understanding. She always takes time to listen to my concerns. She’s the best!

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

  • Dr. Kristina Jackson is always on time for my appointments. The staff is very friendly and knowledgeable. It’s a pleasure to visit this office!
  • Dr. Timothy Loughran – All staff I had contact with were professional, courteous and understanding of my concerns. I would definitely recommend this practice.

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

  • The care is always excellent. Dr. Kathryn Hollett is attentive and knowledgeable!

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

  • Dr. Victor Carabba & his staff were very caring & knowledgeable during my visit. Dr. Carabba listened to me & answered all my questions.
  • Dr. Karen Damico is a kind, caring & bright. She’s been integral in getting me the best care possible. Never rushes & listens intently. Consider myself lucky to have her! A great staff as well!

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

  • I was very pleased to meet the latest addition to the practice. Initial impression of Dr. Erinn Murphy is very good!

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

  • Dr. Jana Oettinger is caring, knowledgeable and compassionate!
  • I felt it was an excellent visit. Dr. Matthew Plosker was thoughtful, a great listener, and proposed an excellent care plan. Staff was also friendly and helpful.

Blackburn Primary Care, Gloucester – 1 Blackburn Drive

  • Dr. Jay Isaac & Beth have always shown me kindness and respect. They are patient with my questions and concerns, always making sure that I understand.

Cape Ann Medical Center, Gloucester – 1 Blackburn Drive

  • Dr. Janet Doran is very respectful and professional.
  • Dr. Shawn Pawson is a great doctor. Always calming and listens to your concerns.

Cape Ann Pediatricians, Gloucester – 298 Washington Street

  • We are incredibly grateful and thankful to have my son seen at the practice. The staff are exceptional and we enjoy Dr. Jeffrey Stockman as my son’s pediatrician. 11/10!

EMTAR Healthcare, Inc., South Hamilton – 205 Willow Street

  • Dr. Michael Edwards was very thorough during my visit. He clearly explained and answered any questions I had. He was kind, and entered the room with a smile. The staff was helpful as well.

Essex County Primary Care, South Hamilton – 42 Asbury Street 

  • Dr. Nicholas Avgerinos is knowledgeable, professional and helpful.

Garden City Pediatrics, Beverly – 83 Herrick Street

  • Every visit that we have with Dr. John Dean and the other GCP staff is above average. We are so fortunate to get such good care for our children from the best pediatrician ever!
  • Dr. Suzanne Graves has taken care of our family for years and has been a wonderful provider in terms of quality healthcare with a caring heart.
  • I love Dr. Meghan Weir! She is knowledgeable, not an alarmist, and accepting. I recommend her to others. The rest of the staff is always lovely as well. I get quick, quality care for my child.

North Shore Pediatrics, Danvers – 480 Maple Street 

  • Dr. David Danis has been nothing but amazing to me and my newborn son. I am very happy to have him as a doctor for my son. He is very kind and overall amazing.
  • Dr. Shannon Dufresne continues to be one of the best decisions we have made for our children. She is fabulous!
  • Dr. Lance Goodman is absolutely amazing!
  • Dr. Filza Kita is great. It was our first visit with her after Dr. Seaman’s transition, and we love her!

Brian Orr Pediatrics, Gloucester – 1 Blackburn Drive

  • Dr. Brian Orr is an amazing doctor who spends time explaining an issue and always makes kid and adult feel comfortable. Dr. Orr is outstanding!

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

  • Dr. Candace Thompson – With every appointment I feel totally heard and seen. The best medical practice I have been a patient of!


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:

The Quality Incentive Award was awarded to Jimena Clogston, Office Manager at Beth Israel Lahey Health Primary Care, Gloucester. Jimena was very helpful working with Laureen on Quality measures. Her certificate read, “For collaborating with NEPHO Quality team to improve care for patients.”

Karen Merchant, Medical Assistant, shown here with David Driscoll, MD at Beth Israel Lahey Health Primary Care and Specialty Care, Beverly Medical Associates. Her certificate read, “Karen, Dr. Driscoll’s assistant, does a fabulous job – she is an asset to her profession and clients! She leaves no stone unturned.”

Lynne Luster of Microsurgical Eye Consultants is our Referral Department Incentive award winner for this month.
Lynne has been exceptional in collaborating with the Northeast PHO in helping keeping care within the 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!