Harvard Pilgrim Health Care Home
  Learn more.
  Sign up for HPHConnect.
Medical Management
For Your Patient
News Center
Network Matters
Newsletter Archives
Newsletter Registration
Office Support
Provider Manual
Medicare Advantage
Research & Teaching
Resources & Links
Print    Text Size

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

March 2018

Enhancements to 271 Eligibility Response Transactions

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.

Email this article to a colleague   

Network Matters Archives

Download printer-friendly version


New Preferred Biologics Drugs for Step Therapy

2017 Physician Group Honor Roll Announced  


Genetic Testing Authorization Updates

Update: Monitored Anesthesia Care for GI for Endoscopic Procedures

Reminder: UM Decision-Making and Communications

National Healthcare Decisions Day Emphasizes Advance Care Planning

Reminder: Refer Members to Participating Laboratories

Reminder: No Cost Share for Naloxone and Narcan Nasal Spray

Gender Reassignment Services Medical Review Criteria Updates

Updated: Invasive Treatment of Urinary Incontinence Criteria

Updates to Formulas and Enteral Nutrition Medical Review Criteria

Updates to Biofeedback Medical Policy

New Codes Covered for Varicose Veins with Prior Authorization


Reminders and Guidelines when Coding for Cancer

Enhancements to 271 Eligibility Response Transactions

Keep Panel Status and Demographic Information Up to Date

Reminder: Use the Correct Form for Provider Changes for Quicker Service


Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Senior Vice President, Corporate Network Strategy

Annmarie Dadoly,

Joseph O'Riordan,

Kristin Edmonston,
Production Coordinator