As a reminder, effective Sept. 1, 2017, Harvard Pilgrim is updating our sleep studies and sleep therapies authorization program. Changes will include:
- Transitioning to a new vendor, National Imaging Associates, Inc. (NIA), to oversee utilization management of sleep diagnostic studies, including attended and home sleep studies, for members age 18 or older with a risk of sleep disorders who are enrolled in Harvard Pilgrim HMO, POS, PPO, and Access America products
- Allowing coverage for the following 5 additional home sleep study codes with prior authorization: 95800; 95801; 95806; G0398; and G0400 — which are being added to applicable Harvard Pilgrim fee schedules (G0399 is currently eligible for coverage and will remain covered)
- Managing requests for sleep durable medical equipment (DME) directly at Harvard Pilgrim
How to Request Prior Authorization
For sleep studies
For sleep DME
Contact NIA beginning Aug. 28, 2017 either:
Note: New users can register for access at www.radmd.com by clicking on “New User” and following the instructions; access is granted within 1-2 days. Existing RadMD users may use their current account.
Contact Harvard Pilgrim’s Referral and Authorization Unit at least one week prior to the date of service in one of the following ways:
- Electronically via HPHConnect or NEHEN
- By phone: 800-708-4414
- By fax: 800-232-0816
Authorization decisions are typically made within 1-2 business days from the time that NIA receives the clinical information necessary.
For further details — including information about the transition; guidance on how to request authorization for sleep studies and sleep therapy equipment; and links to updated policies — please refer to last month’s Network Matters article.
Enroll in a provider education webinar
In addition, Harvard Pilgrim and NIA will be hosting provider education webinars for those who want to learn more about the new NIA-managed sleep program. This one-hour session will provide useful information about the new sleep management program and an opportunity to receive answers to any questions you may have. Provider education webinars will be offered on the following dates:
- Thursday, Aug. 17 at 8 a.m. EST
- Thursday, Aug. 17 at noon EST
- Tuesday, Aug. 22 at 8 a.m. EST
- Tuesday, Aug. 22 at noon EST
- Wednesday, Aug. 23 at 8 a.m. EST
- Wednesday, Aug. 23 at noon EST
- Tuesday, Aug. 29 at 8 a.m. EST
- Tuesday, Aug. 29 at noon EST
To enroll in one of these sessions, please RSVP at least one week prior to the session you plan to attend by emailing NIAWebinar@magellanhealth.com and including the following information in your request:
- “Harvard Pilgrim webinar”
- Webinar date
- Group name
- Phone number
- Number of participants attending from your organization
You will receive a confirmation email from NIA for the webinar session you selected. Please note that you will need a computer with Internet access to view the educational materials presented during the webinar. For further questions, please contact Harvard Pilgrim’s Provider Service Center at 800-708-4414.