At HNE, one of our goals is to provide our members with access to high quality, affordable health care. By monitoring the use of high cost medications, our quality program is designed to support prescribing practices that are appropriate to the patient's situation – so that the right patient has access to the right drug at the right time.

In keeping with our efforts to monitor the escalating costs of our prescription drug benefit, we are requesting that all pharmacy revenue codes (for example 250, 630, and 636) be accompanied by the appropriate HCPCS or CPT code to define the drug associated with the claim.  In the future HNE will require the correct HCPCS or CPT code for payment of pharmacy revenue codes.

If you have any questions about these changes, please contact Donna O'Shea, MD, HNE Associate Medical Director at 413-233-3445 or by e-mail at doshea@hne.com.