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| Network Matters |
News and Information for the
Harvard Pilgrim Health Care Network |
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September 2017
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Highlights
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Update: Commercial Medical Transportation Policy
Based on feedback from our provider partners, Harvard Pilgrim is updating and clarifying our policy requiring prior authorization for non-emergent transportation for our commercial members, which went into effect in May.
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ChoiceNet and Hospital Prefer 2018 Tiers
New tier assignments for Harvard Pilgrim’s ChoiceNet and Hospital Prefer plans take effect on Jan. 1, 2018, and last month Harvard Pilgrim mailed letters notifying physician groups and hospitals whose tier changed of their new tier assignments for these products.
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Prior Authorization for Select Hip, Knee, and Shoulder Surgeries
Effective December 1, 2017, Harvard Pilgrim is requiring prior authorization through National Imaging Associates, Inc. (NIA) for certain non-emergent inpatient and outpatient hip, knee, and shoulder surgeries for commercial members enrolled in our HMO, PPO, and POS products.
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Update to Inpatient Acute Medical Admissions Payment Policy
Harvard Pilgrim’s Inpatient Acute Medical Admissions Payment Policy outlines reimbursement for inpatient acute medical admissions for services rendered at Harvard Pilgrim-contracted facilities and the timeframe for what Harvard Pilgrim considers to be a readmission for diagnosis-related groups (DRGs) and global case rate facilities.
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Payspan and Electronic Funds Transfer Reminders
Harvard Pilgrim would like to offer a few reminders related to Payspan and registering for electronic funds transfer (EFT).
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