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Medical/Clinical Policies

To view Harvard Pilgrim’s medical/clinical policies, including both prior authorization policies and non-prior authorization policies, please select the appropriate product below.

Harvard Pilgrim uses written criteria based on sound clinical evidence to evaluate the medical appropriateness of health care services. These criteria are objective and based on current clinical and medical evidence and applied with consideration of individual needs and characteristics (e.g., age, comorbidities, prior treatment and complications) and the availability of services within the local delivery system. For a hard copy of these policies, please contact the Medical Management department at 617-509-8723.