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

January 2019

Highlights
HPHConnect for Providers Getting a New Look in 2019

New year, new look, greater convenience. Later this month, we’re updating HPHConnect for Providers with a fresh, user-friendly design that’s more than a pretty face — it will offer even greater convenience for users.

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2019 Quality Grant Applications Due by Feb. 15

Harvard Pilgrim would like to invite providers in our network to apply for funding through our 2019 Quality Grants Program.

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HEDIS 2019 Coming Soon: Your Cooperation is Crucial

Each year, the National Committee for Quality Assurance (NCQA) measures the clinical quality performance of health plans across the nation.

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New Opioid Safety Edits for 2019 Medicare Advantage Plans

In response to the current nationwide opioid epidemic, the Centers for Medicare and Medicaid Services (CMS) announced new mandatory strategies in the Contract Year (CY) 2019 Final Call Letter to further assist Medicare Part D plan sponsors in preventing and combating prescription opioid overuse through improved concurrent drug utilization review.

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Reminder: Formulas and Enteral Nutrition Require Prior Authorization

Harvard Pilgrim would like to remind our network that prior authorization is required for all formulas and enteral nutrition requested for members enrolled in commercial products.

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Coding Program Launching in January for Medicare Advantage

Harvard Pilgrim Health Care has engaged Change Healthcare to support complete and accurate claims coding and to help reduce the burden of external medical record audits.

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HPHCURRENT EVENTS

HPHConnect for Providers Getting a New Look in 2019

2019 Quality Grant Applications Due by Feb. 15

HEDIS 2019 Coming Soon: Your Cooperation is Crucial

HPI to Administer BMC HealthNet Plan

Behavioral Health: Services for Improved Access

CLINICIAN CORNER

New Opioid Safety Edits for 2019 Medicare Advantage Plans

Medical Policy Update: Tumor Treating Fields

Reminder: Formulas and Enteral Nutrition Require Prior Authorization

Updates to Proton Beam Therapy Medical Policy

Lumoxiti Now Covered with Prior Authorization

TriVisc and Jivi Now Covered with Prior Authorization

Pharmacy and Therapeutics Committee Meeting Update

OFFICE ASSISTANT

Coding Program Launching in January for Medicare Advantage

PUBLICATION INFORMATION

Robert Farias,
Senior Vice President, Corporate Network Strategy

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator