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

July 2018

Medicare Advantage: New Payment Policy Regarding Inpatient Admissions


Harvard Pilgrim has developed an Inpatient Acute Medical Admissions Payment Policy for Medicare Advantage members. The policy outlines how Harvard Pilgrim reimburses inpatient acute medical admissions and manages readmissions for services rendered at contracted facilities.

Under the policy, which is effective for dates of service beginning Sept. 1, 2018, Harvard Pilgrim will review claims for members who are readmitted to the same facility within 30 days of an inpatient discharge for the same or a related condition for which they were treated during the original admission. If it is determined that the member is being treated at the same facility for the same or a related condition as the original admission, Harvard Pilgrim will not provide separate reimbursement for the readmission.  

For more information, please refer to Harvard Pilgrim’s new StrideSM (HMO) Medicare Advantage Inpatient Acute Medical Admissions Payment Policy.

Email this article to a colleague   


Network Matters Archives

Download printer-friendly version

HPHCURRENT EVENTS

Medicare Advantage: New Payment Policy Regarding Inpatient Admissions

New Online Behavioral Health Pilot Program

CT Pilot Program: GlucoseZone for Personalized Diabetes Management

CLINICIAN CORNER

Update to Harvard Pilgrim’s Gynecomastia Medical Review Criteria

Temodar and Zoladex Prior Authorization Updates

Coverage of Newly Approved Medications With Prior Authorization

Suicide Prevention Resources

OFFICE ASSISTANT

Payment Policy Updates: SNF and Rehabilitation Facility/LTAC

Hierarchical Condition Categories Coding Reminders

PUBLICATION INFORMATION

Robert Farias,
Senior Vice President, Corporate Network Strategy

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator