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

June 2018

GIC Product Updates Effective July 1


The 2018-2019 plan year for Harvard Pilgrim and the Group Insurance Commission’s (GIC’s) Primary Choice HMO and Independence Plan POS begins on July 1, 2018. Any updates to provider tier assignments for these products will take effect on that date. (Providers received their tier assignments in March 2018.) Because Primary Choice is a limited-network product, some of Harvard Pilgrim's contracted providers do not participate in the Primary Choice network. For additional product details, please refer to the GIC Primary Choice HMO and GIC Independence Plan POS product pages in Harvard Pilgrim’s online Provider Manual. For provider tiering information, please visit our provider GIC 2018-2019 Plan Year webpage.

In addition, please be aware that beginning July 1, 2018, the prescription drug benefit for members of Harvard Pilgrim’s GIC HMO and POS plans will be administered by a new pharmacy vendor: Express Scripts. For more information, call Express Scripts at 800.922.8279.

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HPHCURRENT EVENTS

New Program Rewards Medicare Advantage Patients for Healthy Behaviors

GIC Product Updates Effective July 1

Introducing New Hampshire POS Open Access Plans

Harvard Pilgrim Grant Announcements

CLINICIAN CORNER

Coverage of Higher Dosage of Lupron Depot for Breast Cancer

Benign Prostatic Hypertrophy Medical Policy Updates

Cryotherapy for Prostate Cancer Requires Prior Authorization

Coverage of Fecal Calprotectin Testing

Lutathera Covered with Prior Authorization

Updates to TMJ Prior Authorization Policy

Prior Authorization No Longer Required for Cologuard Test

Follow-up WebEx on Reducing Avoidable Hospital Admissions

OFFICE ASSISTANT

Negative Balance and Refund Process Enhancements

Enhanced Processes and Communication with Providers

Keep Panel Status and Demographic Information Up to Date

Early Intervention Provider Fee Schedule Update

2018 Home Care Seasonal Flu Vaccine Fee Schedule

Documenting Deep Vein Thrombus and Pulmonary Embolism

PUBLICATION INFORMATION

Robert Farias,
Senior Vice President, Corporate Network Strategy

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator