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

June 2017

Update to StrideSM (HMO) Medicare Advantage Hysterectomy Criteria

Harvard Pilgrim has updated our StrideSM (HMO) Medicare Advantage medical review criteria for hysterectomy procedures to include criteria for post-menopausal women with abnormal uterine bleeding.

With prior authorization, Harvard Pilgrim covers hysterectomy procedures (vaginal hysterectomy, radical hysterectomy, and hysterectomy with or without bilateral salpingo-oophorectomy) for members who meet the condition-specific criteria outlined in the policy.

Effectively immediately, Harvard Pilgrim covers hysterectomy procedures for post-menopausal women with abnormal uterine bleeding for whom both of the following apply:

  1. Have normal endometrium (no endometrial lesions), confirmed by any of the following within the past 3 months:
    • Endometrial biopsy and ultrasound
    • Hysteroscopy with directed biopsy
    • Dilation and curettage
  2. Used hormone treatment (three months of hormone replacement therapy for atrophy, or progestin for hypertrophy) unless contraindicated

For complete information, please refer to the updated StrideSM (HMO) Medicare Advantage Hysterectomy Medical Review Criteria.

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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