On April 1, 2019, Harvard Pilgrim will update its commercial:
- Standard professional fee schedule, incorporating recently released Medicare relative value units (RVUs) and laboratory rates for 2019. Reimbursement for injectable drugs will be based on 106% of Medicare Average Sales Price (ASP) where applicable.
- Standard professional and hospital fee schedule methodologies for specialty pharmacy drugs to either the standard fee schedule methodology or Harvard Pilgrim’s specialty pharmacy discount, depending on which is lower.
- Durable medical equipment (DME) fees, which may also include changes resulting from Harvard Pilgrim’s annual review of purchase (NU), maintenance (MS), and rental (RR) terms, and item limits.
- MA Chiropractor and Optometry fee schedules to include differential rates when services are provided in a facility setting.
Beginning in mid-February, providers may request 2019 sample fee schedules by calling the Provider Service Center at 800-708-4414.