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

January 2018

Highlights
Genetic Testing Prior Authorization for Commercial Members

Harvard Pilgrim introduced a prior authorization requirement for genetic testing for Medicare Advantage members in January, and will be expanding the program to include commercial members.

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Maximum Dosages for Medical Drugs

As we announced in last month’s issue of Network Matters, Harvard Pilgrim is continuing efforts to ensure the safe, cost-effective, and appropriate use of medications through a new maximum allowed dosage policy.

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Prior Authorization Policy Updates

Harvard Pilgrim has made some updates to our commercial prior authorization policies for breast surgeries, cosmetic and reconstructive nasal procedures, and cosmetic and reconstructive eye procedures.

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2018 Fee Schedule Updates

On April 1, 2018, Harvard Pilgrim will update its Fee Schedule.

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Network Matters Archives

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HPHCURRENT EVENTS

Genetic Testing Prior Authorization for Commercial Members

Maximum Dosages for Medical Drugs

HPI to Administer Boston Medical Center Plan

Update for Dartmouth-Hitchcock and Alice Peck Medical Benefit Plans

Coverage for Out-of-Area Dependents

CLINICIAN CORNER

Prior Authorization Policy Updates

Substance Abuse and Depression in Primary Care

OFFICE ASSISTANT

2018 Fee Schedule Updates

Payment Policy Updates: Billing for Multiple Dates of Service

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