Harvard Pilgrim Health Care Home
  Learn more.
  Sign up for HPHConnect.
Medical Management
Clinical Guidelines
Medical/Clinical Policies
Continuity and Coordination of Care
Disease and Health Risk Management
Quality Program Initiatives
Medical Record Quality
Hospital Quality
Provider Toolkits
Shared Decision Making
Mindfulness for Providers
Network Medical Management
Quality Grants Program
For Your Patient
News Center
Office Support
Provider Manual
Medicare Advantage
Research & Teaching
Resources & Links
Print    Text Size
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.