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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

June 2017

ACA Risk Adjustment Data Validation Reminder: Medical Chart Requests

As a reminder, in support of the Affordable Care Act’s Risk Adjustment Data Validation (RADV) program, beginning this month, you may receive a medical chart request from Harvard Pilgrim pertaining to services provided during the 2016 calendar year. Please keep in mind that:

  1. Medical chart requests may be for a regular patient of yours or someone who was only seen once in your office.
  2. Medical charts must have the patient’s name and date of birth, the date of service, the provider’s signature and credentials, and date of the provider’s signature.
  3. Medical charts must be provided within 14 days to meet Harvard Pilgrim’s audit timeline requirements.
  4. Member authorizations are not required.
  5. Medical chart request materials will include contact information for assistance you or your staff may need.

If you have questions regarding a RADV medical chart request, please contact Kathryn Roach, Program Manager, at 617-509-2199.

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Network Matters Archives

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Changes to Sleep Diagnostic and Sleep Therapy Program

Review of Inpatient Admissions for Appropriate Level of Care

Reminder: Concurrent Review for Inpatient Stays

New Publication on Healthy Eating for Older Adults


Reminder: Expanded Medical Drug Prior Authorization Program

ACA Risk Adjustment Data Validation Reminder: Medical Chart Requests

Update to StrideSM (HMO) Medicare Advantage Hysterectomy Criteria

Updates to Bariatric Surgeries Medical Review Criteria

Updates to Varicose Vein Procedures Medical Review Criteria

Update to Cardiac Event Monitors Medical Policy

Prescribing Statins to Members with Diabetes

Members’ Rights and Responsibilities

Biological Effects of Cannabis and Detriments to Adolescent Development


Telemedicine/Telehealth Payment Policy

Change in Format of Newly Assigned Practitioner and Provider ID Numbers

Credentialing Reminder: Keep Provider Information Up to Date in CAQH

Keep Panel Status and Demographic Information Up to Date


Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Vice President, Network Services

Annmarie Dadoly,

Joseph O'Riordan,

Kristin Edmonston,
Production Coordinator