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

November 2017

Clarification on Inpatient Acute Medical Admissions Policy

In the September 2017 issue of Network Matters, Harvard Pilgrim published an article informing providers that effective Nov. 15, 2017, we are extending the timeframe from 7 days to 30 days for what Harvard Pilgrim considers to be a readmission for diagnosis-related groups (DRGs) and global case rate facilities. 

We would like to clarify that the readmission policy addressed in the September article applies only to members who are readmitted to the same hospital or facility.

Under the updated policy, members who are readmitted to the same hospital or facility 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 to the same facility, reimbursement for 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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Streamlining Provider Enrollment and Credentialing Processes

Webinar for Genetic Testing Authorization

2018 Star Ratings Measure Quality and Patient Satisfaction


Update: 3D Mammography Coverage

Update: Commercial Medical Transportation Policy

Members’ Rights and Responsibilities

PCPs and Behavioral Health Care Providers — Working Together


Clarification on Inpatient Acute Medical Admissions Policy

Update to Evaluation and Management Payment Policy

Accident/Injury Questionnaire for Members


Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Senior Vice President, Network Strategy

Annmarie Dadoly,

Joseph O'Riordan,

Kristin Edmonston,
Production Coordinator