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

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.

Email this article to a colleague   


Network Matters Archives

Download printer-friendly version

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