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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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PUBLICATION INFORMATION

Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Senior Vice President, Network Strategy

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator