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

August 2018

270/271 Eligibility Response Update and Telemedicine Billing Reminders

Harvard Pilgrim is updating our 270/271 eligibility response transactions, to provide more complete information related to members of our Group Insurance Commission (GIC) plans: Primary Choice HMO and Independence Plan POS. Beginning July 1, 2018, the eligibility response transactions for GIC members will display separate telemedicine cost sharing information, if the cost sharing is different than it would be for an office visit. The telemedicine benefit will be found in HPHConnect for providers, under “Additional Information” with the “Benefit Description” of “Telemedicine.” In the EDI 271 eligibility response, it will be noted in a message segment associated with the service type “Consultation.”

Keep in mind that the telemedicine benefit will not be displayed on eligibility transactions for all members; it will only be displayed when there is specific telemedicine cost sharing. As additional plans include the telemedicine benefit, it will appear on eligibility transactions with more frequency. When the telemedicine benefit is not displayed, the lowest tier 1 office visit copay will apply.

As a reminder, it is important to bill correctly for services provided via telemedicine in order to make sure the telemedicine cost sharing applies, and the claim does not adjudicate as if it were for an in-person visit. In this article from the June 2017 issue of Network Matters, we detailed the way in which providers must bill for telemedicine services. All telemedicine services must be reported with either modifier GT (via interactive audio and video telecommunication systems) or 95 (synchronous telemedicine service rendered via a real-time interactive audio and video telecommunication system), and place of service (POS) 02. If you bill for telemedicine services with modifiers GT or 95, but without POS code 02 — or conversely, if you bill with POS code 02, but without modifier GT or 95 — Harvard Pilgrim will deny the service.

For more information, please refer to the Telemedicine/Telehealth Payment Policy.

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Robert Farias,
Senior Vice President, Corporate Network Strategy

Annmarie Dadoly,

Joseph O'Riordan,

Kristin Edmonston,
Production Coordinator