As a reminder, a copy of our Accident/Injury Questionnaire is available on our website. Members are required to complete this form if a claim may be related to an accident, in which case the financial responsibility may reside with another insurer, such as an auto insurer or worker’s compensation program. This information is required in order for the claim to be processed.
While Harvard Pilgrim mails this questionnaire to members with an explanatory letter in the appropriate cases, some providers have also requested access to this form to assist their Harvard Pilgrim patients who may need it and to help expedite processing of these claims. You’ll find this questionnaire in the following places on our website: