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

July 2020

Highlights
Guidance from Massachusetts Governor on Phase 2 Re-Opening

As you are likely aware, Massachusetts Governor Charlie Baker recently announced that Phase 2 of the state’s COVID-19 reopening plan is underway.

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Outpatient Oncology Prior Authorization: Effective on Sept. 1

Harvard Pilgrim will be launching a new oncology and radiation oncology medical management program with a vendor partner, Oncology Analytics.

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Medical Drug Authorization: Dose and Frequency for Sept. 1

For our commercial members, Harvard Pilgrim requires prior authorization for certain medical drugs through our vendor partner, CVS-Novologix.

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InterQual Criteria for Bariatric Surgery

Beginning on Aug. 28, 2020, Harvard Pilgrim will be adopting InterQual criteria for commercial medical review of bariatric surgery.

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Help Us Keep Directory Information Up to Date

The Centers for Medicare & Medicaid Services and other regulatory bodies require health plans to maintain and update data in provider directories, and we rely on our providers to review their data and notify us of any changes as they happen to ensure that members have access to accurate information.

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Reminder: Correct Coding for Principal Procedure Codes

Harvard Pilgrim would like to remind providers that when submitting a principal procedure code on an institutional claim, the code must be a valid ICD-10-PCS procedure code for the date of service.

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Network Matters Archives

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HPHCURRENT EVENTS

Guidance from Massachusetts Governor on Phase 2 Re-Opening

Harvard Pilgrim Providing Aid to Providers, Members and Employers

CLINICIAN CORNER

Outpatient Oncology Prior Authorization: Effective on Sept. 1

Medical Drug Authorization: Dose and Frequency for Sept. 1

Medicare Advantage: Dosage and Frequency Limits

Genetic Counseling No Longer Required Prior to Genetic Testing

InterQual Criteria for Bariatric Surgery

Transgender Health Services Commercial Medical Policy Updates

Medicare Advantage: Prior Authorization Updates

Stride Varicose Veins Procedures Medical Policy Updates

Medicare Advantage: Chest Wall Deformities Reconstructive Policy

Medicare Advantage: Billing for Home Infusion Therapy Services

Help Us Keep Directory Information Up to Date

Xtampza ER Commercial Coverage Update

Pharmacy and Therapeutics Committee Meeting Update

Specialty Pharmacy Program Updates

OFFICE ASSISTANT

Reminder: Correct Coding for Principal Procedure Codes

PUBLICATION INFORMATION

Helen Connaughton,
Director, Network Operations

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator