Harvard Pilgrim has updated our commercial Home Infusion, Maximum Units Per Day, and Injectable and Implantable Outpatient Drugs payment policies, to better reflect appropriate billing practices.
When you are billing a professional claim with more than one date of service on a paper CMS-1500 form, or electronically via an 837P, please bill each date of service on its own line — along with the procedure code and number of units for that individual day. For example, instead of billing with the date range of 6/29/2017 – 6/30/2017 and 12 units on one line, it would be more appropriate to bill 6/29/2017 and 6 units on one line, and 6/30/2017 and 6 units on the next line.
As of March 1, 2018, due to system updates related to Harvard Pilgrim’s new policy on maximum dosages for medical drugs, providers who bill professional claims with a date range may experience claims processing issues resulting in partial reimbursement. The system will recognize only the first date in the range, so each claim line may be subject to the maximum units per date of service policy, and you may not receive payment for the full allowable amount.
If you experience a denial or partial payment because you billed using a date span instead of billing each date of service on its own individual claim line, you can submit a replacement claim within the filing limit of the original claim — the standard is 90 days from the date of service. Harvard Pilgrim recommends submitting these and other claims electronically for ease of use and quicker turnaround times. For guidance on how to bill a replacement claim, refer to our Replacement Claim Billing (UB-04 & CMS-1500) Policy.
For more information, please refer to the following updated policies: