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

June 2018

Negative Balance and Refund Process Enhancements

Harvard Pilgrim would like to remind providers of the tools and resources available to help navigate our updated negative balance and refund check processes, and to inform you of some recent enhancements to the payment summary information in the Payspan printable view, designed to provide more detailed information and allow for greater ease in reconciling your remittance advices.

New reports on negative balance and refunds
As we communicated in a previous issue of Network Matters, Harvard Pilgrim made some changes to our negative balance and refund check processes for our commercial, Medicare Enhance, and Medicare Supplement members.

As a reminder, to make negative balance and refund information more easily accessible for our providers, Harvard Pilgrim has created two new reports — the Negative Balance Report and the Refund Report — both of which are downloadable as Excel files and are available via the Provider Analytics tool in HPHConnect. To assist you in using these reports, please refer to the Negative Balance Report User Guide and Refund Report User Guide. In addition, we have created this document on how to read the 835 provider level adjustments.

Payment summary enhancements
Additionally, for providers who receive electronic funds transfer payments through Payspan, Harvard Pilgrim has enhanced the payment summary information we provide, with the goal of delivering a simpler, more efficient experience.

There are now two summary sections: the “Adjustment Summary” section and the “Total Summary” section. The “Adjustment Summary” section identifies and explains any adjustments made to claims payments, and identifies a reference indicator for the claim, return check number, or re-issued check number. Adjustments referenced in this section include: interest, forward balance remainder, forward balance applied, overpayment, rebate back to the provider, authorized return, overpayment recovery, and a total of all adjustments.

The total summary section will contain the total claims paid, the total of all the adjustments, the balance carried to the next payment, information about insufficient refunds, and the total payment amount. 

More information
For further questions on running these reports or the payment summary information provided in Payspan, please contact Harvard Pilgrim’s Provider eBusiness Services at 800-708-4414, or by email at Provider_eBusiness_Services@harvardpilgrim.org. Also, if you do not currently have an HPHConnect account, we encourage you to sign up by clicking on the registration page in the HPHConnect section of Harvard Pilgrim’s provider website and following the instructions.

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Network Matters Archives

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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


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


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


Robert Farias,
Senior Vice President, Corporate Network Strategy

Annmarie Dadoly,

Joseph O'Riordan,

Kristin Edmonston,
Production Coordinator