Harvard Pilgrim is expanding the benefit details provided in our 271 eligibility response transactions to supply our providers with the most complete information possible. As of March 28, 2018, the 271 eligibility response transaction will include information that reflects member cost sharing for three levels of urgent care services for Harvard Pilgrim products.
The eligibility transaction will provide cost sharing details for the following three levels of urgent care services:
- Convenience Care Clinic (Retail, walk-in, providers contracted and marketed in Harvard Pilgrim’s Provider Directory under the specialty of Convenience Care)
- Urgent Care Clinic (Urgent care freestanding providers contracted and marketed in Harvard Pilgrim’s Provider Directory under the specialty of Urgent Care)
- Hospital (Hospital-billed Urgent Care)
This is a change from the current approach, in which only one level of urgent care benefit is reported on the eligibility transaction (for plans with multiple levels, only the urgent care benefit with the highest cost share value is reported).
In addition to reporting the cost sharing a member would pay when receiving care at the above-mentioned locations, the 271 eligibility response transaction will also include cost sharing information for the different tiers within those places of service, if the member has a tiered plan. For example, it may show the member’s cost sharing amounts for Convenience Care Clinic, Tier 1; Convenience Care Clinic, Tier 2; Urgent Care Clinic, Tier 1; etc.
For any questions you may have, please contact Harvard Pilgrim’s EDI team at EDI_Team@harvardpilgrim.org, or by phone at 800-708-4414.