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

2018 Network Matters archives
 

December

  • Change to Claims Processing for Newborn Care in New Hampshire and Maine
  • Webinars for Medicare Advantage Cardiac Prior Authorization Program
  • Reminder: Prior Authorization for Cervical Spine Procedures
  • Keep Panel Status and Demographic Information Up to Date
  • Medicare Advantage Reminder: Part B Drug vs Part D Drug Benefits
  • Mepsevii and Poteligeo Covered with Prior Authorization
  • Promote the Flu Vaccine to Your Patients for the Current Season
  • Enhancements to Claims Editing and Functionality for Medicare Advantage
  • Reminder: Anatomical Modifiers Are Required When Applicable
November
  • New Emergency Room Cost Sharing Structure for New Hampshire Plans
  • Harvard Pilgrim Regional Network Meeting: Manchester NH Kickoff Event
  • Updates on Medical Drugs Obtained through Specialty Pharmacy
  • Billing Monitored Anesthesia Care Policy for Screening Colonoscopies for Commercial Members
  • Billing Diagnosis Codes for Preventive Services
  • Medicare Advantage: Cardiac Studies Prior Authorization Program
  • Prior Authorization for Cervical Spine Procedures
  • Newly Covered Codes for Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
  • Updates to Rituxan Medical Review Criteria
  • Generic Form of Makena Now Covered
  • Diabetes Prevention and Management Programs and Resources
  • New Pharmacy Prior Authorizations for 2019
  • Pharmacy and Therapeutics Committee Meeting Update
  • Update to Reimbursement Process for Observation to Inpatient Transition
  • Modifier SA for Reporting on Behalf of Non-Physician Practitioners
October
  • Medicare Advantage: Expansion and New Benefits for 2019
  • CAQH Solution Chosen to Improve Provider Directory Accuracy
  • Introducing Maine POS and HMO Open Access Plans
  • SaveOn Program Now Called Reduce My Cost
  • Updates to Antiemetic Therapy Medical Review Criteria
  • Updates to Molecular Genetic Testing Clinical Guidelines
  • Synagis for Upcoming RSV Season
  • Hospital-Based Clinic and Treatment Room Payment Policy Updates
  • 2019 CPT and HCPCS codes
  • Update to Filing Limit for Replacement Claims
September
  • New Product Offerings Focused on Millennials
  • Credentialing for Addiction Medicine
  • GIC Plans: Express Scripts Manages Certain Medical Drugs
  • Advance Care Planning Coverage
  • Update: Medical Review Criteria
  • Criteria Updates for Soliris, Prolia, and Kymriah
  • Medicare Advantage: Chronic Care Improvement Program for Hypertension
  • Billing Diagnosis Codes for Preventive Services
  • Update to Radiology Payment Policy
  • Appropriate Coding for Urine Drug Testing
  • Correct ICD-10-Clinical Modification Coding
  • New Resource for Reading Provider Adjustments in EOP
  • New Details in Claims Rejections for Member Information
August
  • New Partnership Leverages Digital Tech for Care Management
  • Voluntary Home Infusion Program for Remicade and IVIG
  • Promote the Flu Vaccine to Your Patients for the Upcoming Season
  • New HCPCS Codes for Hemlibra and Luxturna
  • Opdivo Approved for an Additional Indication
  • Rebinyn and Durolane to be Covered with Prior Authorization
  • Prior Authorization No Longer Required for Cologuard Test
  • Members’ Rights and Responsibilities
  • Pharmacy & Therapeutics Committee Meeting Update
  • Recognizing Generalized Anxiety Disorder in the Primary Care Setting
  • Home Care Providers: Billing for Postnatal Skilled Nursing Home Visits
  • 270/271 Eligibility Response Update and Telemedicine Billing Reminders
  • Billing for Facility-Based Urgent Care
  • QMB Members Cannot be Billed for Medicare Parts A and B Cost-Sharing Members
July
  • Medicare Advantage: New Payment Policy Regarding Inpatient Admissions
  • New Online Behavioral Health Pilot Program
  • CT Pilot Program: GlucoseZone for Personalized Diabetes Management
  • 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
  • Payment Policy Updates: SNF and Rehabilitation Facility/LTAC
  • Hierarchical Condition Categories Coding Reminders
June
  • 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
  • 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 Avoiding Avoidable Hospital Admissions
  • 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
  • 2017 Home Care Seasonal Flu Vaccine Fee Schedule
  • Documenting Deep Vein Thrombus and Pulmonary Embolism
May
  • New Program Rewards Medicare Advantage Patients for Healthy Behaviors
  • Negative Balance and Refund Process Enhancements
  • Sign Up for a Webinar on Our Genetic Testing Program
  • Decreasing Preventable ED Visits and Hospital Readmissions
  • Coverage of Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
  • Prior Authorization Required for Brineura
  • Prior Authorization Criteria Updated for Xgeva
  • Mental Health Month and Alternative Health Benefits
  • Reminder: Report Condition and Value Codes on Institutional Claims
  • Update to Reimbursement of Codes With PC/TC Indicator of 3
  • Reimbursement of 3D Rendering of Imaging Studies
  • Correct Usage of Modifiers LT, RT, and 50
April
  • Reminder: Medical Drugs & Buy-and-Bill or Specialty Pharmacy
  • Cochlear Implants to Require Prior Authorization
  • Update to Bariatric Surgeries Prior Authorization Policy
  • New Bunionectomy Medical Review Criteria
  • Harvard Pilgrim Adding Coverage for Newly Approved Medications
  • National Healthcare Decisions Day Emphasizes Advance Care Planning
  • Tips for Efficient Pharmacy Prior Authorization Process
  • Complex Case Management Services
  • Disease Management Programs Reinforce Physician Treatment Plans
  • Updates to Medical Policies and Prior Authorization Criteria
  • Policy Update: Replacement of the First Metatarsophalangeal Joint
  • Updates to Implantable Neurostimulators Medical Review Criteria
  • Corneal Collagen Cross-Linking Now Covered
  • New Prior Authorization Policy for Hemlibra
  • New Prior Authorization Policy for Imfinzi
  • Substance User Disorder: Treatment and Helpful Resources
  • P&T Committee Meeting Update
  • Payment Policy Updates: DME and Orthotic and Prosthetic Devices
  • Medical Records: Common Issues and Quick Fixes
March
  • New Preferred Biologics Drugs for Step Therapy
  • 2017 Physician Group Honor Roll Announced
  • Genetic Testing Authorization Updates
  • Update: Monitored Anesthesia Care for GI for Endoscopic Procedures
  • Reminder: UM Decision-Making and Communications
  • National Healthcare Decisions Day Emphasizes Advance Care Planning
  • Reminder: Refer Members to Participating Laboratories
  • Reminder: No Cost Share for Naloxone and Narcan Nasal Spray
  • Gender Reassignment Services Medical Review Criteria Updates
  • Updated: Invasive Treatment of Urinary Incontinence Criteria
  • Updates to Formulas and Enteral Nutrition Medical Review Criteria
  • Updates to Biofeedback Medical Policy
  • New Codes Covered for Varicose Veins with Prior Authorization
  • Reminders and Guidelines when Coding for Cancer
  • Enhancements to 271 Eligibility Response Transactions
  • Keep Panel Status and Demographic Information Up to Date
  • Reminder: Use the Correct Form for Provider Changes for Quicker Service
February
  • Changes to Negative Balance and Refund Processes
  • Maximum Dosages for Medical Drugs
  • Reminder: Prior Authorization for Genetic Testing
  • Saheli Boston Can Help Meet the Needs of South Asian Patients
  • Prior Authorization for Diabetes Management Devices
  • Coverage of Exondys 51 with Prior Authorization
  • PCP Cardiac Medication Adherence Report
  • Member Blood Pressure Quiz
  • Endoscopic Sinus Surgeries Medical Review Criteria Updates
  • Lyme/Tick-Borne Diseases: Use of Parenteral Antibiotics Criteria
  • P&T Committee Meeting Update
  • Specialty Pharmacy Update
  • Members’ Rights and Responsibilities
  • HEDIS Spotlight: Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (IET)
  • Reminder: Use the Correct Form for Provider Changes for Quicker Service
January
  • Genetic Testing Prior Authorization for Commercial Members
  • Maximum Dosages for Medical Drugs
  • HPI to Administer Boston Medical Center Plan
  • Update for Dartmouth-Hitchcock and Alice Peck Medical Benefit Plans
  • Coverage for Out-of-Area Dependents
  • Prior Authorization Policy Updates
  • Substance Abuse and Depression in Primary Care
  • 2018 Fee Schedule Updates
  • Payment Policy Updates: Billing for Multiple Dates of Service

Network Matters Archives

2019

2018