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

November 2017

Streamlining Provider Enrollment and Credentialing Processes


Harvard Pilgrim has made improvements to our provider enrollment and credentialing processes, with a focus on turnaround times, quality, and service. As part of this effort, we recently redesigned our Provider Change Form to display information more clearly and create a simpler experience for providers. Please use this form for demographic changes such as change in address, telephone number, or panel status; changes to local care unit; or a provider termination.

One of the most significant contributors to an efficient experience is Harvard Pilgrim’s timely receipt of all the information required to process provider enrollment changes. Because of the importance of this information in reducing turnaround times, Harvard Pilgrim would like to share the following reminders regarding commonly missing items:

  • Please include the requested effective date of the change.
  • Changes to provider enrollment must be made on a prospective basis, in accordance with Harvard Pilgrim policies and procedures. For example, for demographic changes, such as a change to a provider’s name, address, NPI, or practice status, a minimum of 30 days’ notice is necessary, whereas at least 60 days’ notice is required for the addition of a local care unit or hospital affiliation, or for a termination.
  • Be sure that you include a valid NPI, TIN, and all other applicable provider information.
  • For provider termination changes, the reason for termination is required.
  • Harvard Pilgrim cannot process changes to a PCP’s local care unit affiliation until we have received a termination request from the previous local care unit affiliation.
  • For new or additional specialties or provider types that require credentialing, a W9 and an HCAS Provider Enrollment Form are necessary.

Harvard Pilgrim is also making a change to our credentialing practices for physical, occupational, and speech therapy (PT/OT/ST) providers in New Hampshire, as well as some providers in Connecticut.

Effective Dec. 1, 2017, each PT/OT/ST group will be credentialed and enrolled at the group level. PT/OT/ST practitioners who are part of a group will not be credentialed or contracted individually. This is currently our standard practice for most PT/OT/ST providers, and we are applying it universally to generate greater consistency across all states. PT/OT/ST practitioners who are not part of a group will continue to be credentialed and contracted individually.

If you have any further questions, please contact the Provider Service Center at 800-708-4414.

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