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

June 2018

Enhanced Processes and Communication with Providers

To improve transparency and efficiency, Harvard Pilgrim is updating our processes and communications with providers relating to provider enrollment change requests and claims rejections.

Updates on provider change requests
To keep providers better apprised of the status of their provider enrollment change requests, we developed and began using new notification responses in April. Providers now receive email updates on requests submitted to our Provider Processing Center. We are sending notices confirming our receipt of the request and when work is completed, or informing you when additional information is needed to process the request and how to resubmit. 

Improvements to claim reject letters
In addition, Harvard Pilgrim is updating existing claims reject letters (notifications that a submitted paper claim could not be processed for payment due to missing or incomplete information). Previously, we sent a more general cover letter with the claim attached. This is being replaced with a more robust letter that includes the pertinent information from the claim, eliminating the need to attach the entire claim.

The updated letters, which we will start using in July, will include the reason that the claim was rejected, and the necessary claim identifier information, such as patient account, member name, member number, date of birth, claim number, and date of service. Currently, we use these letters only for claims submitted on paper, which represent about 3–4% of our claims volume.

For more information
If you receive one of these communications and have any questions, please contact the Provider Service Center at 800-708-4414.

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Robert Farias,
Senior Vice President, Corporate Network Strategy

Annmarie Dadoly,

Joseph O'Riordan,

Kristin Edmonston,
Production Coordinator