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

April 2018

Updates to Medical Policies and Prior Authorization Criteria


Harvard Pilgrim regularly reviews our commercial medical policies and prior authorization criteria and makes updates based on the current clinical literature and best practices. As part of this ongoing review, we have updated the following clinical medical policies, which do not require prior authorization:

Harvard Pilgrim also updated the medical review criteria for the following procedures, which currently require prior authorization and will continue to do so:

For more information, please refer to the updated clinical medical policies and medical review criteria.

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    HPHCURRENT EVENTS

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    New Bunionectomy Medical Review Criteria

    Harvard Pilgrim Adding Coverage for Newly Approved Medications

    Tips for Efficient Pharmacy Prior Authorization Process

    Complex Case Management Services

    Disease Management Programs Reinforce Physician Treatment Plans

    Updates to Medical Policies and Prior Authorization Criteria

    Policy Update: Replacement of the First Metatarsophalangeal Joint

    Updates to Implantable Neurostimulators Medical Review Criteria

    Corneal Collagen Cross-Linking Now Covered

    New Prior Authorization Policy for Hemlibra

    New Prior Authorization Policy for Imfinzi

    Substance Use Disorder: Treatment and Helpful Resources

    P&T Committee Meeting Update

    OFFICE ASSISTANT

    Payment Policy Updates: DME and Orthotic and Prosthetic Devices

    Medical Records: Common Issues and Quick Fixes

    PUBLICATION INFORMATION

    Eric H. Schultz,
    President and Chief Executive Officer

    Robert Farias,
    Senior Vice President, Corporate Network Strategy

    Annmarie Dadoly,
    Editor

    Joseph O'Riordan,
    Writer

    Kristin Edmonston,
    Production Coordinator