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

January 2020

Submitting Claims for Members of Certain HPI Accounts


Effective Jan. 1, 2020, Boston Scientific and Kindred Healthcare members residing in Massachusetts, New Hampshire and Maine are being administered by Health Plans, Inc. (HPI) in a joint venture with UMR (United Healthcare’s third-party administrator solution). HPI is a Harvard Pilgrim company.

Submitting Claims for Members

Please keep the following information in mind regarding the correct process for submitting claims for Fidelity Investments, Sedgwick Claims Management Services, Nielsen, Ocean State Job Lot, Boston Scientific and Kindred Healthcare members.

As a result of the HPI-UMR partnership, HPI manages claims from Massachusetts, New Hampshire and Maine providers for these members whereas UMR manages claims from Connecticut, Rhode Island, and Vermont providers for these members.

Submitting Claims for These Members

Provider State

Submit Claims

MA, NH, ME

HPI

Electronic: HPHC Payer ID# 04271

HPHConnect, NEHEN, NEHENNet: Claims will be transferred to HPI for processing.

Web/MD Change Health: Use HPI’s Payer ID# 44273

Paper: Mail to Health Plans Inc., P.O. Box 5199, Westborough, MA 01581

CT, RI, or VT

UMR

Electronic: Payer ID# 39026

Paper: UMR, P.O. Box 30541, Salt Lake City, UT 84130-0541

Note: If you submitted a claim for these members to an incorrect address and received a rejection message, you must resubmit the claim to the appropriate address noted above to ensure receipt of claim and appropriate processing.

Recognizing members

You can recognize these members by their ID cards, which display the Harvard Pilgrim logo on the front of the card and the HPI logo on the back. In addition, the electronic eligibility response will display the plan name as Health Plans/UMR PPO National.

Please note that while HPI members typically are assigned member ID numbers beginning with HH, this is not the case for members of these accounts. For your reference, the group numbers for these accounts are as follows:

  • Fidelity Group # 76-413512
  • Nielson Group # 76-413554
  • Sedgwick Group # 76-413489
  • Ocean State Job Lot Group # 76-413926
  • Boston Scientific Group # 76-414039
  • Kindred Healthcare Group # 76-414055

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PUBLICATION INFORMATION

Robert Farias,
Senior Vice President, Corporate Network Strategy

Helen Connaughton,
Director, Network Operations

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator