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

September 2018

Highlights
New Product Offerings Focused on Millennials

Harvard Pilgrim is offering new benefit solutions aimed at better engaging Millennials in their health.

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Credentialing for Addiction Medicine

Beginning this month, Harvard Pilgrim will add addiction medicine as a subspecialty for medical providers.

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GIC Plans: Express Scripts Manages Certain Medical Drugs

As you are aware, Express Scripts administers the pharmacy prescription drug benefit for Harvard Pilgrim’s active/non-Medicare Group Insurance Commission (GIC) plans — Primary Choice HMO and Independence Plan POS.

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Billing Diagnosis Codes for Preventive Services

As you are aware, as a result of the Patient Protection and Affordable Care Act, Harvard Pilgrim requires that specific in-network preventive services be covered for members without cost sharing.

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Update to Radiology Payment Policy

Harvard Pilgrim is updating our commercial Radiology Payment Policy, effective for dates of service beginning Nov. 1, 2018.

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New Resource for Reading Provider Adjustments in EOP

Building on previous enhancements to our electronic tools and resources, Harvard Pilgrim has developed the Provider Adjustments in the Explanation of Payment document.

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HPHCURRENT EVENTS

New Product Offerings Focused on Millennials

Credentialing for Addiction Medicine

CLINICIAN CORNER

GIC Plans: Express Scripts Manages Certain Medical Drugs

Advance Care Planning Coverage

Update: Medical Review Criteria

Criteria Updates for Soliris, Prolia, and Kymriah

Medicare Advantage: Chronic Care Improvement Program for Hypertension

OFFICE ASSISTANT

Billing Diagnosis Codes for Preventive Services

Update to Radiology Payment Policy

Appropriate Coding for Urine Drug Testing

Correct ICD-10-Clinical Modification Coding

New Resource for Reading Provider Adjustments in EOP

New Details in Claims Rejections for Member Information

PUBLICATION INFORMATION

Robert Farias,
Senior Vice President, Corporate Network Strategy

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator