Provider Enrollment

Processing Initial Health Plan Enrollment

Proper provider enrollment is essential to the accurate reimbursement for healthcare services.  The Northeast PHO (NEPHO) Provider Enrollment team is responsible for ensuring providers are linked to NEPHO and Lahey Clinical Performance Network (LCPN) payor contracts timely and accurately.  NEPHO facilitates the initial enrollment process while recredentialing is handled at the provider/practice level.

NEPHO Provider Enrollment department submits enrollment information for the following payor/products:

Blue Cross Blue Shield of Massachusetts (BCBSMA)

Plan Type Product Type
Commercial HMO
Commercial POS
Commercial PPO/EPO
Medicare Advantage** HMO*
Medicare Advantage** PPO

*Some PCPs are excluded
**Physician participation is optional


Boston Medical Center (BMC) HealthNet 

Plan Type Product Type
MassHealth** MassHealth
MassHealth** CarePlus
QHP** ConnectorCare
QHP** Silver

**Physician participation is optional


CeltiCare [note:payor is terminating product as of 1/1/18]

Plan Type Product Type
QHP** Ambetter

**Physician participation is optional


Cigna

Plan Type Product Type
All All

Commonwealth Care Alliance 

Plan Type Product Type
Dual Eligibles (65+)** SCO

**Physician participation is optional


Fallon 

Plan Type Product Type
Commercial Direct
Commercial Select
Commercial Preferred Choice PPO
Commercial Tiered Choice

Harvard Pilgrim Health Care (HPHC) 

Plan Type Product Type
Commercial HMO
Commercial POS
Commercial PPO/HPI
Commercial/GIC Primary Choice HMO
Commercial/GIC Independence Plan POS
Commercial National (Passport, Access Amer.)
Commercial HMO with Focus
Commercial BMC/BI/Lahey/Partners
Employed Tiered Plans
Medicare Supplement Supplement (Individual)
Medicare Supplement Enhanced (Employer sponsored)
Medicare Advantage Stride*

*Some PCPs are excluded


Minuteman Health (PNA) [note: payor is terminating 1/1/18]

Plan Type Product Type
All All

Tufts Health Plan

Plan Type Product Type
Commercial HMO
Commercial POS
Commercial PPO/EPO
Commercial/GIC Navigator
Commercial/GIC Spirit
Commercial Select Network

Tufts Medicare Preferred

Plan Type Product Type
Medicare Advantage Tufts Medicare Advantage (TMP)
Dual Eligible (65+) Tufts SCO

Tufts Health Public Plans  

Plan Type Product Type
MassHealth Tufts Health Together
QHP Direct ConnectorCare
QHP Direct Platinum
QHP Direct Gold
QHP Direct Silver
QHP Direct Bronze

UniCare/GIC

Plan Type Product Type
Commercial PPO
Commercial Indemnity