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

January 2018

HPI to Administer Boston Medical Center Plan

Effective Jan. 1, 2018, the Boston Medical Center (BMC) employee benefit plan will be administered by Health Plans, Inc. (HPI), a Harvard Pilgrim company. Please be aware of the following regarding this change.

Recognizing members

BMC employees are aware of the change and have been issued new ID cards (see sample below), which display the BMC name and Health Plans logo prominently.

Checking benefits & eligibility

Visit bmc.healthplansinc.com/providers to check benefits and eligibility. Simply click on “Verify Benefits & Eligibility” and follow the onscreen prompts.

PCPs and referrals

As with their previous plan, BMC members on HPI’s Select and Tiered HMO plans must have a PCP to coordinate care. In addition, referrals are necessary for members of Select and Tiered HMO plans for certain services. Please keep in mind that if the PCP is making the referral within his or her established referral circle with Harvard Pilgrim (usually among specialists in the PCP’s care unit), a referral transaction is not required. However, if a PCP is referring the HMO member outside of his or her referral affiliation, a referral transaction is necessary.

In addition, the following services do not require a referral: family planning services; outpatient maternity services; gynecological services; acupuncture; chiropractic care; routine vision exams; emergency and urgent care services; and, any service that requires a review for medical necessity.

To submit a referral to HPI, click on “Get Registered – Referral Portal” and complete and submit the Referral Portal Access Form provided there. If you haven’t already registered to submit referrals to HPI, you’ll need to register online by completing the Referral Portal Access Form. 

Or, if you prefer to submit referrals on paper, you can find these in the Access Forms section of the website.

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Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Senior Vice President, Network Strategy

Annmarie Dadoly,

Joseph O'Riordan,

Kristin Edmonston,
Production Coordinator