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

June 2020

Highlights
COVID-19 Resources Updated in May

Harvard Pilgrim has continued to adapt our policies and operations to address the unique needs of our members and providers in this challenging time and remains committed to working with you throughout this public health crisis.

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GIC Product Updates Effective July 1

The 2020-2021 plan year for Harvard Pilgrim and the Group Insurance Commission’s (GIC’s) Primary Choice HMO and Independence Plan POS begins on July 1, 2020.

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New Access America Value Product

Harvard Pilgrim is introducing a new product offering known as Access AmericaSM Value, which will be available as of July 1, 2020 for fully insured or self-insured multi-state employer groups based in Massachusetts, New Hampshire, and Maine* with 150 or more eligible employees.

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Durable Medical Equipment Payment Policy Updates

Harvard Pilgrim regularly reviews coding practices to ensure that the care delivered to our members is represented as completely and accurately as possible.

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Payment Policy Update: Injectable and Implantable Outpatient Drugs

Harvard Pilgrim is updating our commercial Injectable and Implantable Outpatient Drugs Payment Policy, effective for dates of service beginning Aug. 1, 2020.

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Payment Policy Update: Billing Requirements for Outpatient Revenue Codes

Harvard Pilgrim currently reimburses revenue codes 278 (medical/surgical supplies: other implants) and 636 (drugs requiring detailed coding).

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Network Matters Archives

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HPHCURRENT EVENTS

COVID-19 Resources Updated in May

GIC Product Updates Effective July 1

New Access America Value Product

HPHC-CT Plans Name Change on July 1

CLINICIAN CORNER

Genetic Testing Code Updates

Updates to NIA’s Musculoskeletal Criteria

Cosmetic and Reconstructive Eye Procedures Medical Policy Updates

New Stride Medication Prior Authorizations

Updates to Medicare Advantage Remicade Medical Policy

OFFICE ASSISTANT

2020 Home Care Seasonal Flu Vaccine Fee Schedule

Durable Medical Equipment Payment Policy Updates

Payment Policy Update: Injectable and Implantable Outpatient Drugs

Payment Policy Update: Billing Requirements for Outpatient Revenue Codes

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