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

November 2017

Update: Commercial Medical Transportation Policy


Harvard Pilgrim further updated and clarified our policy requiring prior authorization for non-emergent transportation for our commercial members. Under this policy, which went into effect in May, Harvard Pilgrim requires prior authorization for non-emergent transportation including air (fixed-wing) and ground transportation (ambulance).

Effective immediately, please note that prior authorization is not required for commercial members being transported from a hospital to a skilled nursing facility (H to N). However, prior authorization remains required for non-emergent transport from a skilled nursing facility to a hospital (N to H).

In summary, prior authorization is also not required for commercial members for the following:

  • Transportation between acute care hospitals and mental health facilities (H to H)
  • Transportation between acute care hospitals (H to H)
  • Transportation between an acute care hospital and a long-term acute care facility (LTAC) or inpatient rehabilitation facility (IRF) [H to H]
  • Transportation from a hospital to a skilled nursing facility (H to N)
  • Wheelchair van transports
All other non-emergent transportation requires prior authorization. Providers coordinating transportation should utilize participating medical transportation providers. For complete information, please refer to our updated commercial Medical Transportation Medical Review Criteria and when requesting authorization please complete the Non-Emergent Ground Transportation Prior Authorization Request Form.

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PUBLICATION INFORMATION

Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Senior Vice President, Network Strategy

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Editor

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Production Coordinator