Medical Management

Medical Management Programs

NEHEN (New England Healthcare Electronic Data Interchange Network) Express



NEHEN Express (Logo)

 

NEHEN Express is a web-based referral management application used by BIDPO PCP's and specialists.

 

 


Major Features:

  • Enables PCP and specialty offices to verify member eligibility/benefits for Aetna, BCBSMA, BMC Health Net Plan, CIGNA, Health New England, Harvard Pilgrim Health Care, Neighborhood Health Plan, Network Health, Tufts Health Plan, United Healthcare ,as well as Medicare and Medicaid. There is now a new feature "Self Pay Verify". If you enter the patent's name and date of birth it will search the above plans and return eligibility if found.
  • PCP referral coordinators are able to enter specialty and service referrals for BCBSMA and THP electronically through NEHEN Express, which then downloads to the payors' systems for authorization and claims payment. New payors to be added in the near future are HPHC and NHP.
  • BIDPO specialists do not enter referrals, but can view the system to verify authorization.