Harvard Pilgrim Health Care Home
  HPHConnect
 
  Learn more.
  Sign up for HPHConnect.
Medical Management
E-Transactions
HPHConnect
Pharmacy
For Your Patient
News Center
Network Matters
Newsletter Archives
Newsletter Registration
Newsroom
Office Support
Products
Provider Manual
Medicare Advantage
Research & Teaching
Resources & Links
 
Print    Text Size

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

August 2017

Harvard Pilgrim 270/271 Eligibility Response Enhancements


Harvard Pilgrim has made improvements to our 270/271 eligibility response transactions to make certain information more quickly and easily accessible for providers. The 270/271 eligibility response transaction now includes a “Y” or an “N” indicator to identify if a referral, authorization, or notification is required for each service type. There is no differentiation between the three — the “Y” or “N” listed covers all of them in one field.

Additionally, the eligibility response transaction now indicates that Medicare is the “Primary” coverage for coordination of benefits for Medicare Supplement, Medicare Enhance, and Med Enhance products. We continue to report other primary or secondary commercial insurance, if available.
 
Coming in October, the 270/271 eligibility response transaction will include a new service type for Newborn Nursery Non-Routine, which will be reported as “NI” (Neonatal Intensive Care). As is the case with all existing serving types, this new service type will also have a “Y” or “N” indicator to determine whether a referral, authorization, or notification is required for the service.

Please note that member eligibility and benefit information for Harvard Pilgrim’s StrideSM (HMO) Medicare Advantage products is available through our dedicated Medicare Advantage Provider Portal, and not through Harvard Pilgrim’s 270/271 eligibility response transaction.

If you have any questions about the eligibility response changes, please contact the Harvard Pilgrim EDI Team at EDI_team@harvardpilgrim.org or call 800-708-4414 (select option 1, then option 3).

Email this article to a colleague   


Network Matters Archives

Download printer-friendly version

HPHCURRENT EVENTS

Harvard Pilgrim Selects MedImpact Direct as New Mail-Order Pharmacy

New Sleep Program Reminder and FAQ

Institute Study: Sugary Beverages During Pregnancy Could Contribute to Childhood Obesity

Success at BMC’s Inaugural Boston Trans Health Institute

CLINICIAN CORNER

New Extended Care Facility Prior Authorization Request Form

Updates to Capsule Endoscopy Medical Policy

Billing for Services for Multiple-Gestation Pregnancies

OFFICE ASSISTANT

Reminder: Use our Dedicated StrideSM (HMO) Medicare Advantage Resources

Harvard Pilgrim 270/271 Eligibility Response Enhancements

PUBLICATION INFORMATION

Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Senior Vice President, Network Services

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator