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

September 2017

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. Effective Nov. 15, 2017, Harvard Pilgrim is extending this timeframe from 7 days to 30 days.

Under the updated policy, members who are readmitted within 30 days of an inpatient discharge for the same or a related condition for which they were treated during the original admission may be reviewed. If it is determined that the member is being treated for the same or a related condition as the original admission, the readmission will be retracted.

For more information, please refer to Harvard Pilgrim’s updated Inpatient Acute Medical Admissions Payment Policy.

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