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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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Network Matters Archives

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Update: Commercial Medical Transportation Policy

ChoiceNet and Hospital Prefer 2018 Tiers

Correction: Practitioner and Provider ID Number Format


Prior Authorization for Select Hip, Knee, and Shoulder Surgeries

Changes to Bariatric Surgery Coverage in Connecticut

Updates to Sinus Surgeries Medical Review Criteria

Collaboration among PCPs and Behavioral Health Providers


Update to Inpatient Acute Medical Admissions Payment Policy

Payspan and Electronic Funds Transfer Reminders

Keep Panel Status and Demographic Information Up to Date

ACA Risk Adjustment Data Validation: Medical Chart Requests Underway


Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Senior Vice President, Network Services

Annmarie Dadoly,

Joseph O'Riordan,

Kristin Edmonston,
Production Coordinator