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

January 2018

Update for Dartmouth-Hitchcock and Alice Peck Medical Benefit Plans


Beginning on Jan. 1, 2018, two Health Plans, Inc. (HPI) self-insured employer customers, Dartmouth-Hitchcock and Alice Peck Day Memorial Hospital, will move their utilization management and clinical care management programs to Optum.

HPI, a Harvard Pilgrim company, will continue to administer their medical benefit plans. HPI is a leading regional third-party administrator of customized self-funded benefit plans.

With this change, several services will no longer require precertification for Dartmouth-Hitchcock and Alice Peck Day Memorial Hospital members. The services that will no longer require prior authorization for these members are:

     
  • Physical, occupational and speech therapy
  • Maternity admissions
  • Hospice
  • Outpatient psychological testing in excess of 4 hours
  • Outpatient neuropsychological testing sessions in excess of 9 hours
  • Methadone maintenance in excess of 6 hours
  • Dialysis/hemodialysis initial treatment
  • Pain clinics
  • ABA therapy
  • Court ordered examinations or services
  • External insulin infusion pumps
  • Home visit by nurse after early discharge

You can recognize these members through their member ID cards. Members of the Dartmouth-Hitchcock and Alice Peck Day Memorial Hospital medical plans carry a customized card, which includes the name of the employer group, and logos for Harvard Pilgrim and Health Plans, as shown in the examples below. The back of the card features information on member eligibility verification, claim submission, pharmacy, and prior authorization for inpatient stays.

   
For a list of services that require precertification for Dartmouth-Hitchcock and Alice Peck Day Memorial Hospital medical plan members, or to request authorization for these members, contact Optum at 844-701-5149. You may also access the Optum prior authorization fax forms online at dh.healthplansinc.com/providers/access-forms after Jan. 1, 2018.

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PUBLICATION INFORMATION

Eric H. Schultz,
President and Chief Executive Officer

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Senior Vice President, Network Strategy

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Production Coordinator